Sec Form 4 Filing - FHM VI, L.L.C. @ Allena Pharmaceuticals, Inc. - 2017-11-06

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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
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1. Name and Address of Reporting Person
FHM VI, L.L.C.
2. Issuer Name and Ticker or Trading Symbol
Allena Pharmaceuticals, Inc. [ ALNA]
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 FRAZIER HEALTHCARE PARTNERS, 601 UNION STREET, SUITE 3200
3. Date of Earliest Transaction (MM/DD/YY)
11/06/2017
(Street)
SEATTLE, WA98101
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 11/06/2017 C 2,830,373 A 2,830,373 I By Frazier Healthcare VI, L.P. ( 4 )
Common Stock 11/06/2017 P 500,000 A $ 14 3,330,373 I By Frazier Healthcare VI, L.P. ( 4 )
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 ( 1 ) 11/06/2017 C 6,122,448 ( 1 ) ( 5 ) Common Stock 1,466,805 $ 0 0 I By Frazier Healthcare VI, L.P. ( 4 )
Series B Preferred Stock ( 2 ) 11/06/2017 C 4,629,630 ( 2 ) ( 5 ) Common Stock 1,109,159 $ 0 0 I By Frazier Healthcare VI, L.P. ( 4 )
Series C Preferred Stock ( 3 ) 11/06/2017 C 1,061,904 ( 3 ) ( 5 ) Common Stock 254,409 $ 0 0 I By Frazier Healthcare VI, L.P. ( 4 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
FHM VI, L.L.C.
C/O FRAZIER HEALTHCARE PARTNERS
601 UNION STREET, SUITE 3200
SEATTLE, WA98101
X
FHM VI, L.P.
C/O FRAZIER HEALTHCARE PARTNERS
601 UNION STREET, SUITE 3200
SEATTLE, WA98101
X
Frazier Healthcare VI, L.P.
C/O FRAZIER HEALTHCARE PARTNERS
601 UNION STREET, SUITE 3200
SEATTLE, WA98101
X
Signatures
FHM VI, LLC, /s/ Steve Bailey, Chief Financial Officer 11/06/2017
Signature of Reporting Person Date
FHM VI, L.P., By: FHM VI, L.L.C., its general partner, By: /s/ Steve Bailey, Chief Financial Officer 11/06/2017
Signature of Reporting Person Date
Frazier Healthcare VI, L.P., By: FHM VI, L.P., its general partner, By: FHM VI, L.L.C., its general partner, By: /s/ Steve Bailey, Chief Financial Officer 11/06/2017
Signature of Reporting Person Date
Explanation of Responses:
( 1 )The Series A Preferred Stock automatically converted into Common Stock of the Issuer on a 4.174-to-1 basis upon closing of the initial public offering of the Issuer.
( 2 )The Series B Preferred Stock automatically converted into Common Stock of the Issuer on a 4.174-to-1 basis upon closing of the initial public offering of the Issuer.
( 3 )The Series C Preferred Stock automatically converted into Common Stock of the Issuer on a 4.174-to-1 basis upon closing of the initial public offering of the Issuer.
( 4 )The securities are held by Frazier Healthcare VI, L.P. ("Frazier VI"). FHM VI, L.P. ("FHM LP") is the general partner of Frazier VI and FHM VI, L.L.C. ("FHM LLC") is the general partner of FHM LP. Each of FHM LLC and FHM LP disclaims beneficial ownership of all shares held by Frazier VI except to the extent, if any, of such entity's, as applicable, pecuniary interest therein.
( 5 )Not applicable.

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