0001181431-14-034002.txt : 20141008 0001181431-14-034002.hdr.sgml : 20141008 20141008163315 ACCESSION NUMBER: 0001181431-14-034002 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20141008 FILED AS OF DATE: 20141008 DATE AS OF CHANGE: 20141008 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Dermira, Inc. CENTRAL INDEX KEY: 0001557883 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 273267680 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2055 WOODSIDE ROAD STREET 2: SUITE 270 CITY: REDWOOD CITY STATE: CA ZIP: 94061 BUSINESS PHONE: 650 421 7200 MAIL ADDRESS: STREET 1: 2055 WOODSIDE ROAD STREET 2: SUITE 270 CITY: REDWOOD CITY STATE: CA ZIP: 94061 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: NEA Partners 13, Limited Partnership CENTRAL INDEX KEY: 0001460752 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36668 FILM NUMBER: 141148108 BUSINESS ADDRESS: STREET 1: 1119 ST. PAUL STREET CITY: BALTIMORE STATE: MD ZIP: 21202 BUSINESS PHONE: 410-244-0115 MAIL ADDRESS: STREET 1: 1119 ST. PAUL STREET CITY: BALTIMORE STATE: MD ZIP: 21202 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: NEA 13 GP, Ltd CENTRAL INDEX KEY: 0001460751 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36668 FILM NUMBER: 141148109 BUSINESS ADDRESS: STREET 1: 1119 ST. PAUL STREET CITY: BALTIMORE STATE: MD ZIP: 21202 BUSINESS PHONE: 410-244-0115 MAIL ADDRESS: STREET 1: 1119 ST. PAUL STREET CITY: BALTIMORE STATE: MD ZIP: 21202 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: NEW ENTERPRISE ASSOCIATES 13 LP CENTRAL INDEX KEY: 0001452907 STATE OF INCORPORATION: E9 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36668 FILM NUMBER: 141148110 BUSINESS ADDRESS: STREET 1: 1119 ST PAUL STREET CITY: BALTIMORE STATE: MD ZIP: 21202 BUSINESS PHONE: 410-244-0115 MAIL ADDRESS: STREET 1: 1119 ST PAUL STREET CITY: BALTIMORE STATE: MD ZIP: 21202 4 1 rrd417189.xml X0306 4 2014-10-08 0 0001557883 Dermira, Inc. DERM 0001452907 NEW ENTERPRISE ASSOCIATES 13 LP 1954 GREENSPRING DRIVE SUITE 600 TIMONIUM MD 21093 0 0 1 0 0001460751 NEA 13 GP, Ltd 1954 GREENSPRING DRIVE SUITE 600 TIMONIUM MD 21093 0 0 1 0 0001460752 NEA Partners 13, Limited Partnership 1954 GREENSPRING DRIVE SUITE 600 TIMONIUM MD 21093 0 0 1 0 Common Stock 2014-10-08 4 C 0 3416569 0 A 3433810 D Common Stock 2014-10-08 4 P 0 69112 16 A 3502922 D Series A Preferred Stock 0 2014-10-08 4 C 0 2378408 0 D Common Stock 2378408 0 D Series B Preferred Stock 0 2014-10-08 4 C 0 655321 0 D Common Stock 655321 0 D Series C Preferred Stock 0 2014-10-08 4 C 0 382840 0 D Common Stock 382840 0 D In connection with the consummation of the Issuer's initial public offering on October 8, 2014, each share of Preferred Stock automatically converted into one (1) share of Common Stock for no additional consideration. All shares of Common Stock issued upon conversion were aggregated. The securities are directly held by New Enterprise Associates 13, L.P. ("NEA 13") and are indirectly held by NEA Partners 13, L.P. ("NEA Partners 13"), the sole general partner of NEA 13, NEA 13 GP, LTD ("NEA 13 LTD"), the sole general partner of NEA Partners 13 and each of the individual directors of NEA 13 LTD (NEA Partners 13, NEA 13 LTD and the individual directors of NEA 13 LTD (collectively, the "Directors") together, the "Indirect Reporting Persons"). The Directors of NEA 13 LTD are M. James Barrett, Peter J. Barris, Forest Baskett, Ryan D. Drant, Patrick J. Kerins, Krishna "Kittu" Kolluri, David M. Mott, Scott D. Sandell, Ravi Viswanathan and Harry R. Weller. The Indirect Reporting Persons disclaim beneficial ownership within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise of such portion of the NEA 13 securities in which the Indirect Reporting Persons have no pecuniary interest. None. /s/ Sasha Keough, attorney-in-fact 2014-10-08