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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OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
C/O NOVARTIS INTERNATIONAL |
AG WSJ-200.220 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 03/15/2017
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3. Issuer Name and Ticker or Trading Symbol
Aerpio Pharmaceuticals, Inc.
[ NONE ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Form filed by One Reporting Person |
X |
Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Common Stock |
5,245,550
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I |
See Footnote
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
1. Name and Address of Reporting Person*
C/O NOVARTIS INTERNATIONAL |
AG WSJ-200.220 |
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
Remarks: |
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/s/ Simon Zivi, Chairman /s/ Laurieann Chaikowsky, Authorized signatory |
03/17/2017 |
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/s/ Simon Zivi, Authorized signatory /s/ Laurieann Chaikowsky, Authorized signatory |
03/17/2017 |
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** 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). |
** 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. |
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
POWER OF ATTORNEY
We, the undersigned, under the authority granted to each of us to
sign jointly on behalf of Novartis AG, hereby grant powers to Simon Zivi,
Laurieann Chaikowsky, Michael Jones, David Middleton, Bartosz Dzikowski,
Reinhard Ambros and Campbell Murray and constitute and appoint any two of them
jointly as our true and lawful attorneys and representatives and to act on our
behalf and to sign filings to be made with the U.S. Securities and Exchange
Commission (the "SEC") relating to the shares of Aerpio Therapeutics, Inc. held
by Novartis Bioventures Ltd, an indirect subsidiary of Novartis AG, as required
by the SEC (the "SEC Filings"), and to undertake and carry out all tasks and
formalities on our behalf which may be required in connection with giving effect
to the SEC Filings.
We, the undersigned, undertake to ratify and confirm whatever our
true and lawful attorneys do or purport to do in good faith in the exercise of
any power conferred by this Power of Attorney.
We, the undersigned, declare that a person who deals with our true
and lawful attorneys in good faith may accept a written statement signed by such
attorneys to the effect that this Power of Attorney has not been revoked as
conclusive evidence of that fact.
The authority granted by this Power of Attorney shall expire
immediately after the date on which the SEC Filings are no longer required.
IN WITNESS WHEREOF, this Power of Attorney is duly signed on this 17
day of March 2017.
Novartis AG
By: /s/ Christian Rehm
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Name: Christian Rehm
Title: Authorized Signatory
By: /s/ Katja Roth Pellanda
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Name: Katja Roth Pellanda
Title: Authorized Signatory