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) 05/30/2007 |
3. Issuer Name and Ticker or Trading Symbol
AMICUS THERAPEUTICS INC [ FOLD ] |
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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 | ||||
Series B Convertible Preferred Stock | (1) | (1) | Common Stock | 988,446 | (1) | I(2) | By Frazier Healthcare IV, LP |
Series B Convertible Preferred Stock | (1) | (1) | Common Stock | 5,016 | (1) | I(2) | By Frazier Affiliates IV, LP |
Series C Convertible Preferred stock | (1) | (1) | Common Stock | 1,011,088 | (1) | I(2) | By Frazier Healthcare IV, LP |
Series C Convertible Preferred Stock | (1) | (1) | Common Stock | 5,132 | (1) | I(2) | By Frazier Affiliates IV, LP |
Series D Convertible Preferred Stock | (1) | (1) | Common Stock | 572,310 | (1) | I(2) | By Frazier Healthcare IV, LP |
Series D Convertible Preferred stock | (1) | (1) | Common Stock | 2,904 | (1) | I(2) | By Frazier Affiliates IV, LP |
Warrant to purchase Series B (right to buy) | (3) | (3) | Series B Convertible Preferred Stock | 15,042 | 6.375 | I(2) | By Frazier Healthcare IV, LP |
Warrant to purchase Series B (right to buy) | (3) | (3) | Series B Convertible Preferred Stock | 76 | 6.375 | I(2) | By Frazier Affiliates IV, LP |
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 Issuer's Series B, Series C and Series D convertible preferred stock will automatically be converted into Common Stock, 1-for-1, upon the closing of the Issuer's initial public offering. |
2. These securities are owned directly by the entity listed. Frazier Healthcare IV, LP and Frazier Affiliates IV, LP, are joint filers. FHM IV, LP, the designated filer, serves as the general partner of Frazier Healthcare IV, LP and Frazier Affiliates IV, LP. FHM IV, LP disclaims beneficial ownership of the reported securities, except to the extent of its proportionate pecuniary interest therein. |
3. Warrant to purchase Series B convertible preferred stock will automatically be exercised for cash immediately prior to the closing of the Issuer's initial public offering. The Series B shares will automatically be converted to Common Stock upon the closing of the initial public offering. |
Remarks: |
Exhibit 99.1 Joint Filer Information |
FHM IV, LP By: FHM IV, LLC, its General Partner /s/ Thomas S. Hodge, Chief Operating Officer | 05/30/2007 | |
** 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. |
Exhibit 99.1
Form 3 Joint Filer Information
Name: |
Frazier Healthcare IV, LP |
Address: |
601 Union Street, Suite 3200, Seattle, WA 98101 |
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Designated Filer: |
FHM IV, LP |
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Issuer & Ticker Symbol: |
Amicus Therapeutics, Inc. (FOLD) |
Date of Event Requiring Statement: |
May 30, 2007 |
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Frazier Healthcare IV, LP |
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By: FHM IV, LP, its General Partner |
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By: FHM IV, LLC, its General Partner |
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By: |
/s/ Thomas S. Hodge |
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Thomas S. Hodge, Chief Operating Officer |
Name: |
Frazier Affiliates IV, LP |
Address: |
601 Union Street, Suite 3200, Seattle, WA 98101 |
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Designated Filer: |
FHM IV, LP |
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Issuer & Ticker Symbol: |
Amicus Therapeutics, Inc. (FOLD) |
Date of Event Requiring Statement: |
May 30, 2007 |
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Frazier Affiliates IV, LP |
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By: FHM IV, LP, its General Partner |
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By: FHM IV, LLC, its General Partner |
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By: |
/s/ Thomas S. Hodge |
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Thomas S. Hodge, Chief Operating Officer |