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 |
|
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
XERIS PHARMACEUTICALS INC [ XERS ] |
|||||||||||||
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
5. If Amendment, Date of Original Filed
(Month/Day/Year) 06/20/2018 |
||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
|
Table I - Non-Derivative Securities Beneficially Owned | |||
---|---|---|---|
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) | |||||||
---|---|---|---|---|---|---|---|
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(1)(2) | (5) | (5) | Common Stock | 930,383 | (5) | D | |
Series C Preferred Stock(1)(3) | (5) | (5) | Common Stock | 581,992 | (5) | D | |
Series C Preferred Stock(1)(4) | (5) | (5) | Common Stock | 447,686 | (5) | D |
1. Name and Address of Reporting Person*
(Street)
| ||||||||||||
1. Name and Address of Reporting Person*
(Street)
| ||||||||||||
1. Name and Address of Reporting Person*
(Street)
|
Explanation of Responses: |
1. This Form 3/A is being filed to correct the title of the derivative securities held by the Reporting Persons. |
2. The securities are owned by Palmetto Partners 2014, LP, who is a member of a group with Palmetto Partners, Ltd. and Palmetto Partners 2015, LP. |
3. The securities are owned by Palmetto Partners 2015, LP., who is a member of a group with Palmetto Partners, Ltd. and Palmetto Partners 2014, LP. |
4. The securities are owned by Palmetto Partners, Ltd., who is a member of a group with Palmetto Partners 2014, LP and Palmetto Partners 2015, LP. |
5. Each share of preferred stock is convertible on a 1.78112-for-1 basis into Common Stock at any time at the election of the Reporting Persons and will automatically convert upon the closing of the Issuer's initial public offering into the number of shares of the Issuer's Common Stock shown in column 3 without payment or further consideration. The shares have no expiration date. |
Remarks: |
Palmetto Partners, Ltd., by /s/ Ben D. Smolij, attorney in fact | 06/28/2018 | |
Palmetto Partners 2014, LP, by /s/ Ben D. Smolij, attorney in fact | 06/28/2018 | |
Palmetto Partners 2015, LP, by /s/ Ben D. Smolij, attorney in fact | 06/28/2018 | |
** 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. |