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) 06/04/2020 |
3. Issuer Name and Ticker or Trading Symbol
Applied Molecular Transport Inc. [ AMTI ] |
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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 | 3,619,429 | (1) | I | See Footnotes(2)(5) |
Series B Preferred Stock | (1) | (1) | Common Stock | 257,400 | (1) | I | See Footnotes(3)(5) |
Series C Preferred Stock | (1) | (1) | Common Stock | 574,052 | (1) | I | See Footnotes(4)(5) |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. Each share of the issuer's Series A Preferred Stock, Series B Preferred Stock and Series C Preferred Stock will automatically convert into one share of common stock immediately prior to the completion of the issuer's initial public offering and has no expiration date. |
2. 2,814,640 of these shares are owned directly by The Founders Fund V, LP, 757,139 of these shares are held by The Founders Fund V Principals Fund, LP, and 39,836 of these shares are owned directly by The Founders Fund V Entrepreneurs Fund, LP. |
3. 202,311 of these shares are owned directly by The Founders Fund VI, LP, 50,025 of these shares are owned directly by The Founders Fund VI Principals Fund, LP and 2,515 of these shares are owned directly by The Founders Fund VI Entrepreneurs Fund, LP. |
4. 453,883 of these shares are owned directly by The Founders Fund VI LP, 112,230 of these shares are owned directly by The Founders Fund VI Principals Fund, LP, and 5,643 of these shares are owned directly by The Founders Fund VI Entrepreneurs Fund, LP. |
5. The Founders Fund V Management LLC is the general partner of each of The Founders Fund V, LP, The Founders Fund V Entrepreneurs Fund, LP and The Founders Fund V Principals Fund, LP (the FFV Funds) and exercises investment and voting control over the shares held by the FFV Funds through a management committee comprised of Peter Thiel and Brian Singerman. The Founders Fund VI Management LLC is the general partner of each of The Founders Fund VI, LP, The Founders Fund VI Entrepreneurs Fund, LP and The Founders Fund VI Principals Fund, LP (the FFVI Funds) and exercises investment and voting control over the shares held by the FFVI Funds through a management committee comprised of Peter Thiel and Brian Singerman. Each of Messrs. Thiel and Singerman disclaim beneficial ownership of the shares held by the FFV Funds and the FFVI Funds, except to the extent of their pecuniary interest therein, if any. |
Remarks: |
* Date set forth above represents the effective date of issuer's initial public offering. |
/s/Brian Singerman, Partner of The Founders Fund Management V LLC, General Partner of The Founders Fund V, LP | 06/04/2020 | |
/s/ Brian Singerman, Partner of The Founders Fund Management V, LLC, General Partner of The Founders Fund V Entrepreneurs Fund, LP | 06/04/2020 | |
/s/ Brian Singerman, Partner of The Founders Fund Management V, LLC, General Partner of The Founders Fund V Principals Fund, LP | 06/04/2020 | |
/s/ Brian Singerman, Partner of The Founders Fund Management VI, LLC, General Partner of The Founders Fund VI, LP | 06/04/2020 | |
/s/ Brian Singerman, Partner of The Founders Fund Management VI, LLC, General Partner of The Founders Fund VI Entrepreneurs Fund, LP | 06/04/2020 | |
/s/ Brian Singerman, Partner of The Founders Fund Management VI, LLC, General Partner of The Founders Fund VI Principals Fund, LP | 06/04/2020 | |
** 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. |