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) 06/20/2018 | 3. Issuer Name and Ticker or Trading Symbol Kezar Life Sciences, Inc. [ KZR ] | |||||||||||||
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) |
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 B Preferred Stock, par value $0.001 per share | 06/26/2017 | (1) | Common Stock, par value $0.001 per share | 290,924 | (1) | I(2) | See footnotes(2)(4)(5) |
Series B Preferred Stock, par value $0.001 per share | 06/26/2017 | (1) | Common Stock, par value $0.001 per share | 23,894 | (1) | I(3) | See footnotes(3)(4)(5) |
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. The Series B Preferred Stock, par value $0.001 per share (the "Series B Stock") is convertible into Common Stock, $0.001 par value per share (the "Common Stock") of Kezar Life Sciences, Inc. (the "Company") on a one-for-one basis and has no expiration date. The number of underlying shares of common stock reported in Column 3 reflects a 1-for-5.62 reverse stock split that was effected by the Company on June 8, 2018. |
2. These shares are held of record by A.M. Pappas Life Science Ventures V, LP ("Pappas Ventures"). |
3. These shares are held of record by PV V CEO Fund, LP ("CEO Fund" and, together with Pappas Ventures, the "Pappas Funds"). |
4. AMP&A Management V, LLC ("Management V") is the general partner of each of the Pappas Funds and has a management agreement with Pappas Capital, LLC ("Pappas Capital") whereby Pappas Capital's investment committee has sole power to vote or to direct the vote of, and sole power to dispose or to direct the disposition of, all shares owned by the Pappas Funds. Mr. Arthur Pappas is the sole managing member of Pappas Capital. By virtue of their respective relationships with the Pappas Funds, each of Management V, Pappas Capital and Mr. Pappas may be deemed to indirectly beneficially own the shares of which Pappas Ventures and CEO Fund are the record owners. (continue in footnote 5) |
5. Each of Management V, Pappas Capital and Mr. Pappas disclaims beneficial ownership of the shares reported herein, except to the extent of its or his respective pecuniary interests therein. This report shall not be deemed an admission that such reporting persons are the beneficial owners of such securities for purposes of Section 16 or for any other purpose. |
Remarks: |
Exhibit 24 - Power of Attorney |
/s/ Amanda Keister, attorney-in-fact for Arthur M. Pappas | 06/20/2018 | |
/s/ Amanda Keister, attorney-in-fact for A.M. Pappas Life Science Ventures V, LP | 06/20/2018 | |
/s/ Amanda Keister, attorney-in-fact for PV V CEO Fund, LP | 06/20/2018 | |
/s/ Amanda Keister, attorney-in-fact for AMP&A Management V, LLC | 06/20/2018 | |
/s/ Amanda Keister, attorney-in-fact for Pappas Capital, LLC | 06/20/2018 | |
** 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. |