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Filing Details

Accession Number:: 0000899243-15-001566
Form Type:: 4
Zero Holdings:: No
Publication Time:: 2015-07-23 17:45:04
Reporting Period:: 2015-07-21

Filing Date:: 2015-07-23
Accepted Time:: 2015-07-23 17:45:04
SEC Url:: Form 4 Filing

Issuer

Cik	Name	Symbol	Sector (SIC)	IRS No
1339469	Chiasma Inc	CHMA	Pharmaceutical Preparations (2834)	000000000

Insiders

Cik	Name	Reported Address	Insider Title	Director	Officer	Large Shareholder	Other
1648136	7-Med Health Ventures Lp	16B Shenkar Street, P.o.b. 12327 Herzliya Pituach L3 46733		No	No	Yes	No
1648833	Ruth Wertheimer	16B Shenkar Street, P.o.b. 12327 Herzliya Pituach L3 46733		No	No	Yes	No

Reported Non-Derivative Transactions

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Sec. Name	Acquisiton - Disposition	Date	Amount	Price	Remaning Holdings	Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
Common Stock	Acquisiton	2015-07-21	12,337	$0.00	12,337	No	4	C	Direct
Common Stock	Acquisiton	2015-07-21	760,656	$0.00	772,993	No	4	C	Direct
Common Stock	Acquisiton	2015-07-21	514,674	$0.00	1,287,667	No	4	C	Direct
Common Stock	Acquisiton	2015-07-21	328,515	$0.00	1,616,182	No	4	C	Direct
Common Stock	Acquisiton	2015-07-21	273,762	$0.00	273,762	No	4	C	Indirect	Directly owned by Ruth Wertheimer
Common Stock	Acquisiton	2015-07-21	93,750	$16.00	93,750	No	4	P	Indirect	Directly owned by Ruth Wertheimer

Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
No	4	C	Direct
No	4	C	Direct
No	4	C	Direct
No	4	C	Direct
No	4	C	Indirect	Directly owned by Ruth Wertheimer
No	4	P	Indirect	Directly owned by Ruth Wertheimer

Reported Derivative Transactions

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Sec. Name	Sec. Type	Acquisiton - Disposition	Date	Amount	Price	Amount - 2	Price - 2
Common Stock	Series B1' Convertible Preferred Stock	Acquisiton	2015-07-21	112,665	$0.00	12,337	$0.00
Common Stock	Series C' Convertible Preferred Stock	Acquisiton	2015-07-21	6,946,314	$0.00	760,656	$0.00
Common Stock	Series D' Convertible Preferred Stock	Acquisiton	2015-07-21	4,700,000	$0.00	514,674	$0.00
Common Stock	Series E Convertible Preferred Stock	Acquisiton	2015-07-21	3,000,000	$0.00	328,515	$0.00
Common Stock	Series E Convertible Preferred Stock	Acquisiton	2015-07-21	2,500,000	$0.00	273,762	$0.00

Equity Swap Involved	Transaction Form Type	Transaction Code	Nature of Ownership
No	4	C	Direct
No	4	C	Direct
No	4	C	Direct
No	4	C	Direct
No	4	C	Indirect

Footnotes

Each outstanding share of the Issuer's Series B-1' Preferred Stock, Series C' Preferred Stock, Series D' Preferred Stock and Series E Preferred Stock converted into 0.109505 of a share of the Issuer's Common Stock immediately prior to the closing of the Issuer's initial public offering without payment of consideration. The converted shares had no expiration date.
Besides the shares of Common Stock and warrants to purchase shares of Common Stock held directly by Ruth Wertheimer, she also owns (i) an indirect, 80.5% limited partnership interest in 7 Med Health Ventures LP, as well as (ii) 100% of the outstanding equity interests of the general partner of 7 Med Health Ventures LP. She may therefore be deemed to have an indirect pecuniary interest in the shares of Common Stock and Warrants to purchase Common Stock of the Issuer held by 7 Med Health Ventures LP.
Ruth Wertheimer disclaims beneficial ownership of securities held by 7 Med Health Ventures LP except to the extent of her pecuniary interest therein.
The Reporting Person purchased the shares of Common Stock reported in this row in the Issuer's registered initial public offering in the United States.
Each share of the Issuer's Series B1' preferred stock, Series C preferred stock, Series D' preferred stock and Series E preferred stock was automatically converted on a 9.132-for-1 basis into common stock immediately prior to the closing of the Issuer's initial public offering. The shares of Series B1', Series C' and Series D' and Series E preferred stock had no expiration date.