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) 07/15/2015 | 3. Issuer Name and Ticker or Trading Symbol CHIASMA, INC [ CHMA ] | |||||||||||||
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-1' Preferred Stock | (1) | (1) | Common Stock | 10,426 | (1) | I | See Footnote(2) |
Series C' Preferred Stock | (1) | (1) | Common Stock | 2,488,171 | (1) | I | See Footnote(3) |
Series D' Preferred Stock | (1) | (1) | Common Stock | 1,759,381 | (1) | I | See Footnote(4) |
Series E Preferred Stock | (1) | (1) | Common Stock | 1,423,566 | (1) | I | See Footnote(5) |
Warrant (Right to Buy) | 06/24/2011 | 06/24/2016 | Common Stock | 54,752 | 0.0913 | I | See Footnote(6) |
Warrant (Right to Buy) | 10/22/2012 | 10/22/2022 | Common Stock | 513,281 | 0.0913 | I | See Footnote(7) |
Warrant (Right to Buy) | 03/28/2013 | 03/28/2022 | Common Stock | 513,281 | 0.0913 | I | See Footnote(7) |
Warrant (Right to Buy) | 12/16/2014 | 12/16/2024 | Common Stock | 355,889 | 9.132 | I | See Footnote(8) |
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: |
1. Each share of Series B-1' Preferred Stock, Series C' Preferred Stock, Series D' Preferred Stock and Series E Preferred Stock is convertible into 0.109505 of a share of Common Stock without payment of further consideration and will automatically convert into 0.109505 of a share of Common Stock immediately prior to the closing of the Issuer's initial public offering without payment of further consideration. The shares have no expiration date. |
2. The shares are held as follows: 9,773 by MPM BioVentures IV-QP, L.P. ("BV IV QP"), 376 by MPM BioVentures IV GmbH & Co. Beteiligungs KG ("BV IV KG") and 277 by MPM Asset Management Investors BV4 LLC ("AM BV4"). MPM BioVentures IV GP LLC ("BV GP LLC") and MPM BioVentures IV LLC ("BV LLC") are the direct and indirect general partners of BV IV QP and BV IV KG and BV LLC is the manager of AM BV4. Ansbert Gadicke, Luke Evnin, Vaughn M. Kailian, James Paul Scopa and Todd Foley are the members of BV LLC. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of his or its respective pecuniary interest therein. |
3. The shares are held as follows: 1,479,910 by BV IV QP, 57,016 by BV IV KG, 42,083 by AM BV4 and 909,162 by MPM Bio IV NVS Strategic Fund, L.P. ("BV IV SF"). BV GP LLC and BV LLC are the direct and indirect general partners of BV IV SF. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of his or its respective pecuniary interest therein. |
4. The shares are held as follows: 1,539,486 by BV IV QP, 59,313 by BV IV KG, 43,776 by AM BV4 and 116,806 by BV IV SF. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of his or its respective pecuniary interest therein. |
5. The shares are held as follows: 939,089 by BV IV QP, 36,179 by BV IV KG, 26,704 by AM BV4 and 421,594 by BV IV SF. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of his or its respective pecuniary interest therein. |
6. The warrants are held as follows: 51,316 by BV IV QP, 1,977 by BV IV KG and 1,459 by AM BV4. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of his or its respective pecuniary interest therein. |
7. The warrants are held as follows: 481,068 by BV IV QP, 18,534 by BV IV KG and 13,679 by AM BV4. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of his or its respective pecuniary interest therein. |
8. The warrants are held as follows: 234,772 by BV IV QP, 9,044 by BV IV KG, 6,675 by AM BV4 and 105,398 BV IV SF. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of his or its respective pecuniary interest therein. |
Remarks: |
By Luke Evnin, member of MPM BioVenture IV LLC, the managing member of MPM BioVentures IV GP LLC, the general partner of MPM BioVentures IV-QP, L.P. /s/ Luke Evnin | 07/15/2015 | |
/s/ Luke Evnin | 07/15/2015 | |
/s/ James Paul Scopa | 07/15/2015 | |
/s/ Vaughn M. Kailian | 07/15/2015 | |
By Luke Evnin, member of MPM BioVenture IV LLC, the manager of MPM Asset Management Investors BV4 LLC /s/ Luke Evnin | 07/15/2015 | |
By Luke Evnin, member of MPM BioVenture IV LLC, the managing member of MPM BioVentures IV GP LLC, the general partner of MPM Bio IV NVS Strategic Fund, L.P. /s/ Luke Evnin | 07/15/2015 | |
By Luke Evnin, member of MPM BioVenture IV LLC, the managing member of MPM BioVentures IV GP LLC, the managing limited partner of MPM BioVentures IV GmbH & Co. Beteiligungs KG /s/ Luke Evnin | 07/15/2015 | |
By Luke Evnin, member of MPM BioVenture IV LLC, the managing member of MPM BioVentures IV GP LLC /s/ Luke Evnin | 07/15/2015 | |
By Luke Evnin, member of MPM BioVenture IV LLC /s/ Luke Evnin | 07/15/2015 | |
** 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. |