0001209191-14-028931.txt : 20140423
0001209191-14-028931.hdr.sgml : 20140423
20140423191345
ACCESSION NUMBER: 0001209191-14-028931
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20140423
FILED AS OF DATE: 20140423
DATE AS OF CHANGE: 20140423
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: VITAL THERAPIES INC
CENTRAL INDEX KEY: 0001280776
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 15222 AVENUE OF SCIENCE, SUITE B
CITY: SAN DIEGO
STATE: CA
ZIP: 92128
BUSINESS PHONE: 858-673-6840
MAIL ADDRESS:
STREET 1: 15222 AVENUE OF SCIENCE, SUITE B
CITY: SAN DIEGO
STATE: CA
ZIP: 92128
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Godshall Douglas Evan
CENTRAL INDEX KEY: 0001404227
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36201
FILM NUMBER: 14779808
MAIL ADDRESS:
STREET 1: SUITE 4 LEVEL 46 2 PARK STREET
CITY: SIDNEY
STATE: C3
ZIP: 2000
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2014-04-23
0
0001280776
VITAL THERAPIES INC
VTL
0001404227
Godshall Douglas Evan
C/O VITAL THERAPIES, INC.
15010 AVENUE OF SCIENCE, SUITE 200
SAN DIEGO
CA
92128
1
0
0
0
Common Stock
2014-04-23
4
P
0
12500
12.00
A
12500
D
Common Stock
2014-04-23
4
C
0
54018
A
66518
D
Senior Convertible Preferred Stock
2014-04-23
4
C
0
54018
0.00
D
Common Stock
54018
0
D
Each share of Senior Convertible Preferred Stock automatically converted into the Registrant's common stock on a one-for-one basis immediately prior to the closing of the Registrant's initial public offering and had no expiration date.
/s/ Michael V. Swanson, by power of attorney
2014-04-23