SEC Form 4 · accession 0000903423-15-000328

HTG MOLECULAR DIAGNOSTICS, INC · HTGM

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

10% Owner

Period of report

May 11, 2015

Accepted (ET)

May 13, 2015 · 12:36 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001169987

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F2	May 11, 2015	P	365,106	$14.00	A	365,106	I	By S.R. One, Limited
Common Stock^F3,F2	May 11, 2015	C	340,314	—	A	705,420	I	By S.R. One, Limited
Common Stock^F3,F2	May 11, 2015	C	141,797	—	A	847,217	I	By S.R. One, Limited
Common Stock^F3,F2	May 11, 2015	J	91,271	—	A	938,488	I	By S.R. One, Limited
Common Stock^F5,F2	May 11, 2015	C	110,755	—	A	1,049,243	I	By S.R. One, Limited

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Series D Convertible Preferred Stock^F2,F3	—	May 11, 2015	C	36,546,366	D	—	—	Common Stock	340,314	0	I
Series E Convertible Preferred Stock^F2,F3	—	May 11, 2015	C	15,227,653	D	—	—	Common Stock	141,797	0	I
Subordinated Convertible Promissory Note^F2,F5	—	May 11, 2015	C	110,755	D	—	Mar 31, 2016	Common Stock	110,755	0	I
Series E Convertible Preferred Stock Warrant (Right to Buy)^F2,F6	—	May 11, 2015	C	2,784,593	D	—	Jan 14, 2022	Common Stock	2,784,593	0	I
Common Stock Warrant (Right to Buy)^F2,F6	—	May 11, 2015	C	43,538	A	—	Jan 14, 2022	Common Stock	43,538	43,538	I

F1Shares purchased in the Issuer's initial public offering at the initial public offering price of $14.00 per share.
F2Shares are held of record by S.R. One, Limited, an indirect, wholly-owned subsidiary of GlaxoSmithKline plc (Reporting Person).
F3Each share of Series D Convertible Preferred Stock and Series E Convertible Preferred Stock, including all accrued cumulative and unpaid dividends thereon, converted automatically into Common Stock on a 1-for-107.39 basis, upon the closing of the Issuer's initial public offering. Both the Series D Convertible Preferred Stock and the Series E Convertible Preferred Stock had no expiration date.
F4Shares of Common Stock acquired upon payment of shares in respect of dividends accrued on Series D Convertible Preferred Stock and Series E Convertible Preferred Stock at the closing of the Issuer's initial public offering.
F5The Convertible Promissory Note, including all accrued and unpaid interest thereon, converted automatically into Common Stock upon the closing of the Issuer's initial public offering.
F6The right to receive 2,784,593 Series E Shares upon exercise of the Warrants converted automatically into a right to receive 43,538 shares of Common Stock upon exercise of the Warrants, which can be exercised at any time, at an exercise price of $14.00, upon the closing of the Issuer's initial public offering.