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)
| 2. Date of Event Requiring Statement (Month/Day/Year) 06/16/2015 | 3. Issuer Name and Ticker or Trading Symbol Nivalis Therapeutics, Inc. [ NVLS ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
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) |
Common Stock | 82,211 | I | Through Deerfield Private Design Fund, L.P.(2)(3)(4) |
Common Stock | 132,453 | I | Through Deerfield Private Design International, L.P.(2)(3)(4) |
Common Stock | 189,358 | I | Through Deerfield Special Situations Fund, L.P.(2)(3)(4) |
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 | ||||
Series 1 Convertible Preferred Stock | (1) | (1) | Common Stock | 301,027 | (1) | I | Through Deerfield Private Design Fund, L.P.(1)(2)(3)(4) |
Series 1 Convertible Preferred Stock | (1) | (1) | Common Stock | 484,945 | (1) | I | Through Deerfield Private Design International, L.P.(1)(2)(3)(4) |
Series 1 Convertible Preferred Stock | (1) | (1) | Common Stock | 375,592 | (1) | I | Through Deerfield Private Design Fund II, L.P.(1)(2)(3)(4) |
Series 1 Convertible Preferred Stock | (1) | (1) | Common Stock | 430,400 | (1) | I | Through Deerfield Private Design International II, L.P.(1)(2)(3)(4) |
Series 1 Convertible Preferred Stock | (1) | (1) | Common Stock | 696,994 | (1) | I | Through Deerfield Special Situations Fund, L.P.(1)(2)(3)(4) |
Series 2 Convertible Preferred Stock | (1) | (1) | Common Stock | 18,826 | (1) | I | Through Deerfield Private Design Fund, L.P.(1)(2)(3)(4) |
Series 2 Convertible Preferred Stock | (1) | (1) | Common Stock | 29,755 | (1) | I | Through Deerfield Private Design International, L.P.(1)(2)(3)(4) |
Series 2 Convertible Preferred Stock | (1) | (1) | Common Stock | 282,985 | (1) | I | Through Deerfield Private Design Fund II, L.P.(1)(2)(3)(4) |
Series 2 Convertible Preferred Stock | (1) | (1) | Common Stock | 324,279 | (1) | I | Through Deerfield Private Design International II, L.P.(1)(2)(3)(4) |
Series 2 Convertible Preferred Stock | (1) | (1) | Common Stock | 133,598 | (1) | I | Through Deerfield Special Situations Fund, L.P.(1)(2)(3)(4) |
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: |
1. Each share of Series 1 convertible preferred stock and Series 2 convertible preferred stock is convertible into shares of common stock on a 1-for-2.889 basis at the option of the reporting person or upon the occurrence of certain events. All outstanding shares of Series 1 convertible preferred stock and Series 2 convertible preferred stock are expected to convert into shares of common stock immediately prior to the amendment and restatement by Nivalis Therapeutics, Inc. of its certificate of incorporation, provided the amendment and restatement occurs prior to, and on the same day as, the closing of its initial public offering at an initial public offering price of no less than $8.667 per share. |
2. This Form 3 is being filed by the undersigned as well as the entities listed on the Joint Filer Information Statement attached as an exhibit hereto (the "Reporting Persons"). |
3. Deerfield Mgmt, L.P. is the general partner of Deerfield Private Design Fund, L.P., Deerfield Private Design International, L.P., Deerfield Private Design Fund II, L.P., Deerfield Private Design International II, L.P., and Deerfield Special Situations Fund, L.P. (collectively, the "Funds"). Deerfield Management Company, L.P. is the investment manager of the Funds. James E. Flynn is the sole member of the general partner of each of Deerfield Mgmt, L.P. and Deerfield Management Company, L.P. |
4. In accordance with Instruction 5(b)(iv) to Form 3, the entire amount of the Issuer's securities held by the Funds is reported herein. For purposes of Section 16 of the Securities Exchange Act of 1934, as amended, each Reporting Person disclaims beneficial ownership of any such securities, except to the extent of his/its indirect pecuniary interest therein, if any, and this report shall not be deemed an admission that such Reporting Person is the beneficial owner of such securities for purposes of Section 16 or otherwise. |
Remarks: |
Jonathan Isler, Attorney-in-Fact: Power of Attorney, which is hereby incorporated by reference to Exhibit 24 to a Form 3 with regard to Avalanche Biotechnologies, Inc. filed with the Securities and Exchange Commission on July 30, 2014 by Deerfield Mgmt III, L.P., Deerfield Mgmt, L.P., Deerfield Management Company, L.P., Deerfield Special Situations Fund, L.P., Deerfield Special Situations International Master Fund, L.P., Deerfield Private Design Fund III, L.P. and James E. Flynn. |
/s/ Jonathan Isler | 06/16/2015 | |
** 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. |