SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
Mario Family Credit LLC Series D

(Last) (First) (Middle)
P.O. BOX 445
20 FAIRMOUNT AVENUE

(Street)
CHATHAM NJ 07928

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/25/2018
3. Issuer Name and Ticker or Trading Symbol
Liquidia Technologies Inc [ LQDA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Warrant to Purchase Series D Preferred Stock 02/17/2017 12/31/2026 Series D Preferred Stock(1) 18,630(1)(2) (1)(2) D(3)
Series D Preferred Stock (1) (1) Common Stock 107,791 (1) D(3)
1. Name and Address of Reporting Person*
Mario Family Credit LLC Series D

(Last) (First) (Middle)
P.O. BOX 445
20 FAIRMOUNT AVENUE

(Street)
CHATHAM NJ 07928

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Mario Jeremy

(Last) (First) (Middle)
P.O. BOX 445
20 FAIRMOUNT AVENUE

(Street)
CHATHAM NJ 07928

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Melmotte LLC

(Last) (First) (Middle)
P.O. BOX 445
20 FAIRMOUNT AVENUE

(Street)
CHATHAM NJ 07928

(City) (State) (Zip)
Explanation of Responses:
1. All shares of Series D Preferred Stock, par value $0.001 per share (the "Series D Preferred Stock"), have no expiration date and will automatically convert into the Issuer's common stock on approximately a 0.0594-for-1 basis immediately prior to the closing of the initial public offering.
2. Following the automatic conversion of Series D Preferred Stock, the Warrant to Purchase Series D Preferred Stock will be exercisable into 18,630 shares of the Issuer's common stock at an exercise price of $0.01 per share.
3. This report on Form 3 is jointly filed by Mario Family Credit LLC Series D, Melmotte LLC and Mr. Mario. Melmotte LLC is the manager of Mario Family Credit LLC Series D, and Mr. Mario is the managing member of Melmotte LLC. Each of the reporting persons disclaims beneficial ownership of the securities reported herein for purposes of Rule 16a-1(a) under the Securities Exchange Act of 1934, as amended (the "Exchange Act"), except to the extent of its or his pecuniary interest therein, if any. This report shall not be deemed an admission that any of the reporting persons is a beneficial owner of such securities for the purposes of Section 16 of the Exchange Act, or for any other purposes.
MARIO FAMILY CREDIT LLC SERIES D By: Melmotte LLC, its Manager By: Jeremy Mario, Managing Member of Melmotte LLC MELMOTTE LLC By: Jeremy Mario, Managing Member By: Jeremy Mario 07/25/2018
** 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 5 (b)(v).
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