| FORM 4 |
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 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | ||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Applied Molecular Transport Inc. [ AMTI ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 06/09/2020 | ||||||||||||||||||||||||||
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4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 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 | 06/09/2020 | C | 656,194 | A | (1) | 656,194 | I | See footnotes(2)(12) | ||
| Common Stock | 06/09/2020 | C | 162,255 | A | (1) | 162,255 | I | See footnotes(3)(12) | ||
| Common Stock | 06/09/2020 | C | 2,814,640 | A | (1) | 2,814,640 | I | See footnotes(4)(11) | ||
| Common Stock | 06/09/2020 | C | 39,836 | A | (1) | 39,836 | I | See footnotes(5)(11) | ||
| Common Stock | 06/09/2020 | C | 8,158 | A | (1) | 8,158 | I | See footnotes(6)(12) | ||
| Common Stock | 06/09/2020 | C | 757,139 | A | (1) | 757,139 | I | See footnotes(7)(11) | ||
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 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 (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (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: 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) | 06/09/2020 | C | 3,619,429 | (1) | (1) | Common Stock | 3,619,429 | $0.00 | 0 | I | See footnotes(8)(11)(12) | |||
| Series B Preferred Stock | (1) | 06/09/2020 | C | 257,400 | (1) | (1) | Common Stock | 257,400 | $0.00 | 0 | I | See footnotes(9)(11)(12) | |||
| Series C Preferred Stock | (1) | 06/09/2020 | C | 574,052 | (1) | (1) | Common Stock | 574,052 | $0.00 | 0 | I | See footnotes(10)(11)(12) | |||
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 outstanding share of Series A Preferred Stock, Series B Preferred Stock and Series C Preferred Stock converted into one share of Issuer's Common Stock immediately prior to the completion of the issuer's initial public offering, and the shares of Series A Preferred Stock, Series B Preferred Stock and Series C Preferred had no expiration date. |
| 2. These shares are held directly by The Founders Fund VI, LP. |
| 3. These shares are held directly by The Founders Fund VI Principals Fund, LP. |
| 4. These shares are held directly by The Founders Fund V, LP. |
| 5. These shares are held directly by The Founders Fund V Entrepreneurs Fund, LP. |
| 6. These shares are held directly by The Founders Fund VI Entrepreneurs Fund, LP. |
| 7. These shares are held directly by The Founders Fund V Principals Fund, LP. |
| 8. 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. |
| 9. 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. |
| 10. 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. |
| 11. 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. |
| 12. 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: |
| /s/ Brian Singerman, Partner of Founders Fund Management V, LLC, General Partner of The Founders Fund V, LP | 06/11/2020 | |
| /s/ Brian Singerman, Partner of Founders Fund Management V, LLC, General Partner of The Founders Fund V Entrepreneurs Fund, LP | 06/11/2020 | |
| /s/ Brian Singerman, Partner of Founders Fund Management V, LLC, General Partner of The Founders Fund V Principals Fund, LP | 06/11/2020 | |
| /s/ Brian Singerman, Partner of Founders Fund Management VI, LLC, General Partner of The Founders Fund VI, LP | 06/11/2020 | |
| /s/ Brian Singerman, Partner of Founders Fund Management VI, LLC, General Partner of The Founders Fund VI Entrepreneurs Fund, LP | 06/11/2020 | |
| /s/ Brian Singerman, Partner of Founders Fund Management VI, LLC, General Partner of The Founders Fund VI Principals Fund, LP | 06/11/2020 | |
| ** 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 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. | ||