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*
Nashat Amir

(Last) (First) (Middle)
C/O POLARIS PARTNERS
ONE MARINA PARK DRIVE, 10TH FLOOR

(Street)
BOSTON MA 02210

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Scholar Rock Holding Corp [ SRRK ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
05/29/2018
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 05/29/2018 C 330,948 A (1) 330,948 I See Footnotes(2)(3)
Common Stock 05/29/2018 C 19,340 A (1) 19,340 I See Footnote(4)
Common Stock 05/29/2018 C 493,705 A (1) 824,653 I See Footnotes(2)(3)
Common Stock 05/29/2018 C 28,851 A (1) 48,191 I See Footnote(4)
Common Stock 05/29/2018 C 479,634 A (1) 1,304,287 I See Footnotes(2)(3)
Common Stock 05/29/2018 C 28,028 A (1) 76,219 I See Footnote(4)
Common Stock 05/29/2018 C 260,670 A (1) 1,564,957 I See Footnotes(2)(3)
Common Stock 05/29/2018 C 15,233 A (1) 91,452 I See Footnote(4)
Common Stock 05/29/2018 C 693,294 A (1) 2,258,251 I See Footnotes(2)(3)
Common Stock 05/29/2018 C 40,514 A (1) 131,966 I See Footnote(4)
Common Stock 05/29/2018 C 283,090 A (1) 2,541,341 I See Footnotes(2)(3)
Common Stock 05/29/2018 C 16,542 A (1) 148,508 I See Footnote(4)
Common Stock 05/29/2018 P 134,970 A $14 2,676,311 I See Footnotes(2)(3)
Common Stock 05/29/2018 P 7,887 A $14 156,395 I See Footnote(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 (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-1 Preferred Stock (1) 05/29/2018 C 944,789 (1) (1) Common Stock 330,948 (1) 0 I See Footnotes(2)(3)
Series A-1 Preferred Stock (1) 05/29/2018 C 55,211 (1) (1) Common Stock 19,340 (1) 0 I See Footnote(4)
Series A-2 Preferred Stock (1) 05/29/2018 C 1,409,429 (1) (1) Common Stock 493,705 (1) 0 I See Footnotes(2)(3)
Series A-2 Preferred Stock (1) 05/29/2018 C 82,363 (1) (1) Common Stock 28,851 (1) 0 I See Footnote(4)
Series A-3 Preferred Stock (1) 05/29/2018 C 1,369,259 (1) (1) Common Stock 479,634 (1) 0 I See Footnotes(2)(3)
Series A-3 Preferred Stock (1) 05/29/2018 C 80,016 (1) (1) Common Stock 28,028 (1) 0 I See Footnote(4)
Series A-4 Preferred Stock (1) 05/29/2018 C 744,162 (1) (1) Common Stock 260,670 (1) 0 I See Footnotes(2)(3)
Series A-4 Preferred Stock (1) 05/29/2018 C 43,487 (1) (1) Common Stock 15,233 (1) 0 I See Footnote(4)
Series B Preferred Stock (1) 05/29/2018 C 1,979,216 (1) (1) Common Stock 693,294 (1) 0 I See Footnotes(2)(3)
Series B Preferred Stock (1) 05/29/2018 C 115,659 (1) (1) Common Stock 40,514 (1) 0 I See Footnote(4)
Series C Preferred Stock (1) 05/29/2018 C 808,166 (1) (1) Common Stock 283,090 (1) 0 I See Footnotes(2)(3)
Series C Preferred Stock (1) 05/29/2018 C 47,225 (1) (1) Common Stock 16,542 (1) 0 I See Footnote(4)
Explanation of Responses:
1. Each share of Preferred Stock automatically converted into Common Stock, for no additional payment or consideration, on a 2.8548-for-1 basis upon the closing of the Issuer's initial public offering on May 29, 2018 and had no expiration date.
2. The reportable securities are owned directly by Polaris Venture Partners VI, L.P. ("PVP VI"). Polaris Venture Management Co. VI, L.L.C. ("PVM VI") is the general partner of PVP VI and PVM VI is managed by its managing members, one of whom is the Reporting Person and a member of the Issuer's Board of Directors (collectively, the "Managing Members"). PVM VI may be deemed to have sole voting and dispositive power with respect to the shares held by PVP VI and each of the Reporting Person and the other Managing Members may be deemed to have shared voting and dispositive power with respect to the shares held by PVP VI.
3. Each of the Reporting Person, PVM VI and the other Managing Members disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the Reporting Person, PVM VI or any of the other Managing Members is a beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of their respective pecuniary interests therein.
4. The reportable securities are owned directly by Polaris Venture Partners Founders' Fund VI, L.P. ("PVPFF VI"). PVM VI is the general partner of PVPFF VI. PVM VI may be deemed to have sole voting and dispositive power with respect to the shares held by PVPFF VI and each of the Reporting Person and the other Managing Members may be deemed to have shared voting and dispositive power with respect to the shares held by PVPFF VI. Each of the Reporting Person, PVM VI and the other Managing Members disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the Reporting Person, PVM VI or any of the other Managing Members is a beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of their respective pecuniary interests therein.
/s/ Junlin Ho, Attorney-in-Fact for Amir Nashat 05/31/2018
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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