SEC Form 3
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 03/20/2023 |
3. Issuer Name and Ticker or Trading Symbol
CalciMedica, Inc. [ CALC ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
Remarks: |
No securities beneficially owned. |
No securities are beneficially owned. |
Sanderling Ventures Partners VI, L.P. By: /s/ Fred Middleton, Managing Director of Middleton, McNeil & Mills Associates VI, LLC, its General Partner | 10/10/2023 | |
Sanderling Venture Partners VI Co-Investment Fund, L.P., By: /s/ Fred Middleton, Managing Director of MIddleton, McNeil & Mills Associates VI, LLC, its General Partner | 10/10/2023 | |
Sanderling Ventures Management VI, By: /s/ Fred Middleton, Owner | 10/10/2023 | |
Sanderling VI Beteiligungs GmbH & Co. KG, By: /s/ Fred Middleton, Managing Director of Middleton, McNeil & Mills Associates VI, LLC, its Managing Limited Partner | 10/10/2023 | |
Sanderling VI Limited Partnership, By: Fred Middleton, Managing Director of Middleton, McNeil & Mills Associates VI, LLC, its Investment Partner | 10/10/2023 | |
Sanderling Ventures VII, L.P. , By: /s/ Fred Middleton, Managing Director of M4 Partners VII, LLC, its General Partner | 10/10/2023 | |
Sanderling Ventures VII Annex Fund, L.P., By: /s/ Fred Middleton. M4 Partners VII Annex, LLC, its General Partner | 10/10/2023 | |
Sanderling Ventures VII (Canada), L.P., By: /s/ D. Michael Dixon, President of Sanderling Ventures VII (Canada) GP Inc., General Partner of Sanderling Ventures VII (Canada), GP, L.P., its General Partner | 10/10/2023 | |
Sanderling Ventures Management VII By: /s/ Fred Middleton, Owner | 10/10/2023 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |