SEC FORM 4 SEC Form 4
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*
KAKKIS EMIL D

(Last) (First) (Middle)
C/O ULTRAGENYX PHARMACEUTICAL INC.
60 LEVERONI COURT

(Street)
NOVATO CA 94949

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Ultragenyx Pharmaceutical Inc. [ RARE ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
President & CEO
3. Date of Earliest Transaction (Month/Day/Year)
02/05/2014
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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 02/05/2014 C 624,240 A (1) 624,240 D
Common Stock 2,552,241 I By Emil Kakkis and Jenny Soriano Living Trust, dated June 18, 2009
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 (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) 02/05/2014 C 1,956,686 (1) (1) Common Stock 624,240(2) $0.00 0 D
Warrant to Purchase Series A Preferred Stock (Right to Buy) $0.959 02/05/2014 J 260,688(3) 06/16/2011 06/30/2020 Series A Preferred Stock 260,688 $0.00 0 D
Warrant to Purchase Common Stock (Right to Buy) $3.01 02/05/2014 J 83,039(3) 06/11/2011 06/30/2020 Common Stock 83,039 $0.00 0 D
Warrant to Purchase Series A Preferred Stock (Right to Buy) $0.959 02/05/2014 J 78.206(3) 06/16/2011 06/14/2021 Series A Preferred Stock 78,206 $0.00 0 D
Warrant to Purchase Common Stock (Right to Buy) $3.01 02/05/2014 J 24,950(3) 06/16/2011 06/14/2021 Common Stock 24,950 $0.00 0 D
Warrant to Purchase Series A Preferred Stock (Right to Buy) $0.959 02/05/2014 J 130,344(3) 06/16/2011 06/14/2021 Series A Preferred Stock 130,344 $0.00 0 D
Warrant to Purchase Common Stock (Right to Buy) $3.01 02/05/2014 J 41,583(3) 06/16/2011 06/14/2021 Common Stock 41,583 $0.00 0 D
Explanation of Responses:
1. The Series A Convertible Preferred Stock converted into the Issuer's common stock on a 1 for 3.1345 basis, such that every 3.1345 shares of Series A Convertible Preferred Stock converted into one share of common stock, and had no expiration date.
2. Reflects a 1-for-3.1345 reverse stock split which became effective on January 17, 2014.
3. Immediately prior to the closing of the Issuer's initial public offering, this warrant to purchase shares of Series A Preferred Stock automatically converted on a 1-for-3.1345 basis into a warrant to purchase shares of Common Stock. Disposition of Warrant to Purchase Series A Preferred Stock and acquisition of Warrant to Purchase Common Stock listed solely for the purpose of reporting such conversion of the shares underlying the security.
Remarks:
By: /s/ Ryan Murr by power of attorney for Emil D. Kakkis, M.D., Ph.D. 02/06/2014
** 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.
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