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) 05/07/2019 |
3. Issuer Name and Ticker or Trading Symbol
Trevi Therapeutics, Inc. [ TRVI ] |
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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 A Preferred Stock | (1) | (1) | Common Stock | 128,211 | (1) | D | |
Series A Preferred Stock | (1) | (1) | Common Stock | 27,426 | (1) | I | By Trevi 2014 Irrevocable Trust |
Series A Preferred Stock | (1) | (1) | Common Stock | 13,268 | (1) | I | By Spinnaker Trust as Trustee for Trevi 2014 Irrevocable Trust |
Series B Preferred Stock | (2) | (2) | Common Stock | 116,345 | (2) | D | |
Series C Preferred Stock | (3) | (3) | Common Stock | 55,902 | (3) | D | |
Stock Option (right to buy) | (4) | 03/10/2023 | Common Stock | 4,211 | $3.14 | D | |
Stock Option (right to buy) | (5) | 01/22/2024 | Common Stock | 3,878 | $3.23 | D | |
Stock Option (right to buy) | (6) | 07/01/2024 | Common Stock | 5,925 | $2.19 | D | |
Stock Option (right to buy) | (7) | 11/24/2024 | Common Stock | 4,555 | $1.43 | D | |
Stock Option (right to buy) | (8) | 12/19/2027 | Common Stock | 26,316 | $3.33 | D |
Explanation of Responses: |
1. The Series A Preferred Stock and the dividends that have accrued thereon to date are convertible on a 9.5-for-one basis into the number of shares of Common Stock shown in Column 3 without payment of further consideration at the holder's election or automatically upon the closing of the Issuer's initial public offering. The number of shares of Common Stock into which the Series A Preferred Stock and accrued dividends thereon are convertible will increase on a daily basis without payment of further consideration as additional dividends accrue. The shares have no expiration date. |
2. The Series B Preferred Stock and the dividends that have accrued thereon to date are convertible on a 9.5-for-one basis into the number of shares of Common Stock shown in Column 3 without payment of further consideration at the holder's election or automatically upon the closing of the Issuer's initial public offering. The number of shares of Common Stock into which the Series B Preferred Stock and accrued dividends thereon are convertible will increase on a daily basis without payment of further consideration as additional dividends accrue. The shares have no expiration date. |
3. The Series C Preferred Stock and the dividends that have accrued thereon to date are convertible on a 9.5-for-one basis into the number of shares of Common Stock shown in Column 3 without payment of further consideration at the holder's election or automatically upon the closing of the Issuer's initial public offering. The number of shares of Common Stock into which the Series C Preferred Stock and accrued dividends thereon are convertible will increase on a daily basis without payment of further consideration as additional dividends accrue. The shares have no expiration date. |
4. This option was granted on March 11, 2013. The 4,211 shares of common stock underlying the option vested over four years from the date of grant in equal monthly installments. |
5. This option was granted on January 23, 2014. The 3,878 shares of common stock underlying the option vested over four years from the date of grant in equal monthly installments. |
6. This option was granted on July 2, 2014. The 5,925 shares of common stock underlying the option vested over four years from June 11, 2014 in equal monthly installments. |
7. This option was granted on November 25, 2014. The 4,555 shares of common stock underlying the option vested as to 25% of the shares on November 25, 2015 and as to the remaining 75% of the shares in equal quarterly installments thereafter through November 25, 2018. |
8. This option was granted on December 20, 2017. The 26,316 shares of common stock underlying the option are scheduled to vest over four years from the date of grant in equal quarterly installments. |
Remarks: |
Exhibit Index: 24.1 Power of Attorney |
/s/ David P. Meeker | 05/07/2019 | |
** 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. |