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*
GLAXOSMITHKLINE PLC

(Last) (First) (Middle)
980 GREAT WEST ROAD

(Street)
BRENTFORD MIDDLESEX X0 TW8 9GS

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Liquidia Technologies Inc [ LQDA ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
Officer (give title below) X Other (specify below)
Former 10% holder
3. Date of Earliest Transaction (Month/Day/Year)
07/30/2018
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 07/30/2018 C 336,541 A (3) 475,604(2) I See explanation of responses(5)
Common Stock 07/30/2018 C 118,570 A (4) 475,604(2) I See explanation of responses(5)
Common Stock 07/30/2018 P(1) 148,818 A $11(1) 624,422(2) I See explanation of responses(5)
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 C-1 Preferred Stock (3) 07/30/2018 C 4,765,248 (3) (3) Common Stock 118,570 $0 0 I See explanation of responses(5)
Series D Preferred Stock (4) 07/30/2018 C 344,853 (4) (4) Common Stock 336,541 $0 0 I See explanation of responses(5)
Explanation of Responses:
1. On July 30, 2018, Glaxo Group Limited acquired 148,818 common shares of the Issuer ("Common Stock") at a price of $11.00 per share in connection with the Issuer's initial public offering.
2. Includes 20,493 shares of Common Stock issuable upon exercise of Series D Warrants. The Series D Warrants are currently exercisable, with an expiration date of December 31, 2026 and an exercise price of $0.01 per share. The exercise price may be paid in cash or through net share settlement at the option of the warrantholder.
3. The Series C-1 Preferred Stock converted automatically into Common Stock on an approximately 0.0706-for-one basis upon closing of the Issuer's initial public offering. The Series C-1 Preferred Stock had been convertible at any time at the holder's election and had no expiration date
4. The Series D Preferred Stock converted automatically into Common Stock on an approximately 0.0594 -for-one basis upon closing of the Issuer's initial public offering. The Series D Preferred Stock had been convertible at any time at the holder's election and had no expiration date.
5. The shares reported herein are held of record by Glaxo Group Limited, an indirect, wholly-owned subsidiary of GlaxoSmithKline plc (the "Reporting Person").
/s/ Victoria Whyte 07/30/2018
** 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 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).
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