SEC FORM 3/A 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*
Palmetto Partners, Ltd.

(Last) (First) (Middle)
109 N. POST OAK LANE, SUITE 600

(Street)
HOUSTON 77024

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/20/2018
3. Issuer Name and Ticker or Trading Symbol
XERIS PHARMACEUTICALS INC [ XERS ]
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)
06/20/2018
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
Series B Preferred Stock(1)(2) (5) (5) Common Stock 930,383 (5) D
Series C Preferred Stock(1)(3) (5) (5) Common Stock 581,992 (5) D
Series C Preferred Stock(1)(4) (5) (5) Common Stock 447,686 (5) D
1. Name and Address of Reporting Person*
Palmetto Partners, Ltd.

(Last) (First) (Middle)
109 N. POST OAK LANE, SUITE 600

(Street)
HOUSTON 77024

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Palmetto Partners 2014, LP

(Last) (First) (Middle)
109 N. POST OAK LANE, SUITE 600

(Street)
HOUSTON TX 77024

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Palmetto Partners 2015, LP

(Last) (First) (Middle)
109 N. POST OAK LANE, SUITE 600

(Street)
HOUSTON TX 77024

(City) (State) (Zip)
Explanation of Responses:
1. This Form 3/A is being filed to correct the title of the derivative securities held by the Reporting Persons.
2. The securities are owned by Palmetto Partners 2014, LP, who is a member of a group with Palmetto Partners, Ltd. and Palmetto Partners 2015, LP.
3. The securities are owned by Palmetto Partners 2015, LP., who is a member of a group with Palmetto Partners, Ltd. and Palmetto Partners 2014, LP.
4. The securities are owned by Palmetto Partners, Ltd., who is a member of a group with Palmetto Partners 2014, LP and Palmetto Partners 2015, LP.
5. Each share of preferred stock is convertible on a 1.78112-for-1 basis into Common Stock at any time at the election of the Reporting Persons and will automatically convert upon the closing of the Issuer's initial public offering into the number of shares of the Issuer's Common Stock shown in column 3 without payment or further consideration. The shares have no expiration date.
Remarks:
Palmetto Partners, Ltd., by /s/ Ben D. Smolij, attorney in fact 06/28/2018
Palmetto Partners 2014, LP, by /s/ Ben D. Smolij, attorney in fact 06/28/2018
Palmetto Partners 2015, LP, by /s/ Ben D. Smolij, attorney in fact 06/28/2018
** 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).
** 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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