Sec Form 4 Filing - TPG Group Holdings (SBS) Advisors, Inc. @ Trevi Therapeutics, Inc. - 2019-05-09

FORM 4 Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940

OMB APPROVAL OMB Number: 3235-0287 Expires: November 30, 2011 Estimated average burden hours per response... 0.5

1. Name and Address of Reporting Person TPG Group Holdings (SBS) Advisors, Inc. 2. Issuer Name and Ticker or Trading Symbol Trevi Therapeutics, Inc. [ TRVI] 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) _____ Director X __ 10% Owner _____ Officer (give title below) _____ Other (specify below) (Last) (First) (Middle) C/O TPG GLOBAL, LLC, 301 COMMERCE STREET, SUITE 3300 3. Date of Earliest Transaction (MM/DD/YY) 05/09/2019 (Street) FORT WORTH, TX76102 4. If Amendment, Date Original Filed (MM/DD/YY) 6. Individual or Joint/Group Filing (Check Applicable Line) _____ Form filed by One Reporting Person __ X __ Form filed by More than One Reporting Person (City) (State) (Zip)

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1.Title of Security (Instr. 3) 2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4) Code V Amount (A) or (D) Price Common Stock 05/09/2019 C 5,773,000 A $ 0 5,773,000 I See Explanation of Responses ( 1 ) ( 2 ) ( 8 ) ( 9 ) Common Stock 05/09/2019 P( 3 ) 800,000 A $ 10 6,573,000 I See Explanation of Responses ( 1 ) ( 3 ) ( 8 ) ( 9 ) Common Stock 05/09/2019 J( 4 ) 48,681 D $ 0 6,524,319 I See Explanation of Responses ( 1 ) ( 4 ) ( 8 ) ( 9 )

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities) 1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) 6. Date Exercisable and Expiration Date (MM/DD/YY) 7. Title and Amount of Underlying Securities (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4) Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares Series A Preferred Stock ( 5 ) 05/09/2019 C 13,164,257 ( 5 ) ( 5 ) Common Stock 1,876,575 ( 5 ) 0 I See Explanation of Responses ( 1 ) ( 2 ) ( 8 ) ( 9 ) Series B Preferred Stock ( 5 ) 05/09/2019 C 21,739,130 ( 5 ) ( 5 ) Common Stock 2,945,488 ( 5 ) 0 I See Explanation of Responses ( 1 ) ( 2 ) ( 8 ) ( 9 ) Series C Preferred Stock ( 5 ) 05/09/2019 C 8,243,948 ( 5 ) ( 5 ) Common Stock 950,937 ( 5 ) 0 I See Explanation of Responses ( 1 ) ( 2 ) ( 8 ) ( 9 ) Call Option (obligation to sell) ( 6 ) 05/09/2019 J( 6 ) 1 ( 6 ) ( 6 ) ( 6 ) Common Stock 1,500,000 $ 0 1 ( 6 ) I See Explanation of Responses ( 1 ) ( 6 ) ( 8 ) ( 9 ) Call Option (obligation to sell) ( 7 ) 05/09/2019 J( 7 ) 1 ( 7 ) ( 7 ) ( 7 ) Common Stock 200,000 $ 0 1 ( 7 ) I See Explanation of Responses ( 1 ) ( 7 ) ( 8 ) ( 9 )

Reporting Owners Reporting Owner Name / Address Relationships Director 10% Owner Officer Other TPG Group Holdings (SBS) Advisors, Inc. C/O TPG GLOBAL, LLC 301 COMMERCE STREET, SUITE 3300 FORT WORTH, TX76102 X BONDERMAN DAVID C/O TPG GLOBAL, LLC 301 COMMERCE STREET, SUITE 3300 FORT WORTH, TX76102 X COULTER JAMES G C/O TPG GLOBAL, LLC 301 COMMERCE STREET, SUITE 3300 FORT WORTH, TX76102 X Signatures /s/ Michael LaGattaBy: Michael LaGatta, Vice President,TPG Group Holdings (SBS) Advisors, Inc. (10) 05/13/2019 Signature of Reporting Person Date /s/ Bradford BerensonBy: Bradford Berenson, on behalf ofDavid Bonderman (10) (11) 05/13/2019 Signature of Reporting Person Date /s/ Bradford BerensonBy: Bradford Berenson, on behalf ofJames G. Coulter (10) (11) 05/13/2019 Signature of Reporting Person Date

Explanation of Responses:

( 1 )David Bonderman and James G. Coulter are the sole shareholders of TPG Group Holdings (SBS) Advisors, Inc. (together with Messrs. Bonderman and Coulter, the "Reporting Persons"), which is the sole member of TPG Group Holdings (SBS) Advisors, LLC, which is the general partner of TPG Group Holdings (SBS), L.P., which is the sole member of TPG Holdings I-A, LLC, which is the general partner of TPG Holdings I, L.P., which is the sole member of TPG Biotechnologies GenPar III Advisors, LLC, which is the general partner of TPG Biotechnology GenPar III, L.P., which is the general partner of TPG Biotechnology Partners III, L.P. ("TPG Biotech III"), which directly holds 6,524,319 shares of Common Stock ("Common Stock") of Trevi Therapeutics, Inc. (the "Issuer"). ( 2 )Pursuant to the Third Amended and Restated Certificate of Incorporation of the Issuer (the "Certificate of Incorporation"), on May 9, 2019, the (a) shares of Series A Preferred Stock of the Issuer (the "Series A Preferred") held by TPG Biotech III automatically converted into 1,876,575 shares of Common Stock, (b) shares of Series B Preferred Stock of the Issuer (the "Series B Preferred") held by TPG Biotech III automatically converted into 2,945,488 shares of Common Stock, and (c) shares of Series C Preferred Stock of the Issuer (the "Series C Preferred" and, together with the Series A Preferred and the Series B Preferred, the "Preferred Stock") held by TPG Biotech III automatically converted into 950,937 shares of Common Stock. ( 3 )On May 9, 2019, in connection with the Issuer's initial public offering, TPG Biotech III acquired 800,000 shares of Common Stock at a price of $10.00 per share. ( 4 )On May 9, 2019 , in connection with the Issuer's initial public offering, TPG Biotech III transferred 48,681 shares of Common Stock to existing stockholders of the Company for no consideration. ( 5 )Pursuant to the Certificate of Incorporation, the Preferred Stock (and, in each case, dividends that had accrued thereon) had been convertible, at the option of the holder, at any time into shares of Common Stock at an initial conversion rate equal to one share of Common Stock per share of Preferred Stock. The initial conversion rate had been adjusted as a result of a 9.5-for-1 reverse stock split of the Common Stock. ( 6 )On May 9, 2019, in connection with the Issuer's initial public offering, TPG Biotech III granted a call option to an existing stockholder of the Company (the "NEA Call Option"). Pursuant to its terms, the NEA Call Option is exercisable at any time by its holder during the period from May 9, 2019 until May 6, 2022. The NEA Call Option may be exercisable once with respect to up to 1,500,000 shares of Common Stock at an exercise price equal to $0.001 per share. ( 7 )On May 9, 2019, in connection with the Issuer's initial public offering, TPG Biotech III granted a call option to an existing stockholder of the Company (the "Omega Call Option"). Pursuant to its terms, the Omega Call Option is exercisable at any time by its holder during the period from May 9, 2019 until May 6, 2022. The Omega Call Option may be exercisable once with respect to up to 200,000 shares of Common Stock at an exercise price equal to $0.001 per share. ( 8 )Because of the relationship between the Reporting Persons and TPG Biotech III, the Reporting Persons may be deemed to beneficially own the securities reported herein to the extent of the greater of their respective direct or indirect pecuniary interests in the profits or capital accounts of TPG Biotech III. Each of TPG Biotech III and each Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of TPG Biotech III's or such Reporting Person's pecuniary interest therein, if any. ( 9 )Pursuant to Rule 16a-1(a)(4) under the Exchange Act, this filing shall not be deemed an admission that the Reporting Persons are, for purposes of Section 16 of the Securities Exchange Act of 1934, as amended (the "Exchange Act") or otherwise, the beneficial owners of any equity securities in excess of their respective pecuniary interests.

Remarks: 10. The Reporting Persons are jointly filing this Form 4 pursuant to Rule 16a-3(j) under the Exchange Act.11. Bradford Berenson is signing on behalf of both Messrs. Bonderman and Coulter pursuant to authorization and designation letters dated March 13, 2018, which were previously filed with the Securities and Exchange Commission.

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 4(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.