SEC FORM 3 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*
Frazier Life Sciences IX, L.P.

(Last) (First) (Middle)
70 WILLOW ROAD, STE. 200

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/17/2019
3. Issuer Name and Ticker or Trading Symbol
Mirum Pharmaceuticals, Inc. [ MIRM ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
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 A Preferred Stock (1) (1) Common Stock 3,116,912(2) (1) D(3)
1. Name and Address of Reporting Person*
Frazier Life Sciences IX, L.P.

(Last) (First) (Middle)
70 WILLOW ROAD, STE. 200

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
FHMLS IX, L.P.

(Last) (First) (Middle)
70 WILLOW ROAD, STE. 200

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
FHMLS IX, L.L.C.

(Last) (First) (Middle)
70 WILLOW ROAD, STE. 200

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Topper James N

(Last) (First) (Middle)
70 WILLOW ROAD, STE. 200

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
Explanation of Responses:
1. The shares of Series A Preferred Stock have no expiration date and are convertible at any time at the election of the holder without payment of further consideration. Each share of Series A Preferred Stock will automatically convert into 0.125 shares of Common Stock upon the closing of the Issuer's initial public offering.
2. Share numbers give effect to the reverse split of each share of the Issuer's Common Stock into 0.125 shares of Common Stock effected on July 3, 2019, which will be effective for the Preferred Stock upon its conversion to Common Stock upon the closing of the Issuer's initial public offering.
3. The shares are held directly by Frazier Life Sciences IX, L.P. FHMLS IX, L.P. is the general partner of Frazier Life Sciences IX, L.P. FHMLS IX, L.L.C. is the general partner of FHMLS IX, L.P. James N. Topper and Patrick Heron are the managing members of FHMLS IX, L.L.C. and share voting and dispositive power over the shares held by Frazier Life Sciences IX, L.P. Mr. Topper, FHMLS IX, L.P. and FHMLS IX, L.L.C. disclaim beneficial ownership of the shares held by Frazier Life Sciences IX, L.P., except to the extent of his or its pecuniary interest therein, if any.
Remarks:
Frazier Life Sciences IX, L.P. By: FHMLS IX, L.P., its general partner, By: FHMLS IX, L.C.C., its general partner, By: /s/ Steve R. Bailey, Chief Financial Officer 07/17/2019
FHMLS IX, L.P. By: FHMLS IX, L.L.C., its general partner, By: /s/ Steve Bailey, Chief Financial Officer 07/17/2019
FHMLS IX, L.L.C. By: /s/ Steve Bailey, Chief Financial Officer 07/17/2019
/s/ Steve Bailey, Attorney-in-Fact for James N. Topper 07/17/2019
** 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).
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