SEC FORM D/A

The Securities and Exchange Commission has not necessarily reviewed the information in this filing and has not determined if it is accurate and complete.
The reader should not assume that the information is accurate and complete.

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

Notice of Exempt Offering of Securities

OMB APPROVAL
OMB Number: 3235-0076
Estimated average burden
hours per response: 4.00

1. Issuer's Identity

CIK (Filer ID Number) Previous Names
X None
Entity Type
0001232524
X Corporation
   Limited Partnership
   Limited Liability Company
   General Partnership
   Business Trust
   Other (Specify)

Name of Issuer
JAZZ PHARMACEUTICALS INC
Jurisdiction of Incorporation/Organization
DELAWARE
Year of Incorporation/Organization
X Over Five Years Ago
   Within Last Five Years (Specify Year)
   Yet to Be Formed

2. Principal Place of Business and Contact Information

Name of Issuer
JAZZ PHARMACEUTICALS INC
Street Address 1 Street Address 2
3180 PORTER DRIVE
City State/Province/Country ZIP/PostalCode Phone Number of Issuer
PALO ALTO CA 94304 650-496-3777

3. Related Persons

Last Name First Name Middle Name
Cozadd Bruce C.
Street Address 1 Street Address 2
c/o Jazz Pharmaceuticals, Inc. 3180 Porter Drive
City State/Province/Country ZIP/PostalCode
Palo Alto CA 94304
Relationship: X Executive Officer X Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Myers Robert M.
Street Address 1 Street Address 2
c/o Jazz Pharmaceuticals, Inc. 3180 Porter Drive
City State/Province/Country ZIP/PostalCode
Palo Alto CA 94304
Relationship: X Executive Officer X Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Colella Samuel D.
Street Address 1 Street Address 2
c/o Versant Ventures 3000 Sand Hill Road, #4-210
City State/Province/Country ZIP/PostalCode
Menlo Park CA 94025
Relationship:    Executive Officer X Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Michaelson Michael W.
Street Address 1 Street Address 2
c/o Kohlberg Kravis Roberts & Co. 2800 Sand Hill Road, Suite 200
City State/Province/Country ZIP/PostalCode
Menlo Park CA 94025
Relationship:    Executive Officer X Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Momtazee James C.
Street Address 1 Street Address 2
c/o Kohlberg Kravis Roberts & Co. 2800 Sand Hill Road, Suite 200
City State/Province/Country ZIP/PostalCode
Menlo Park CA 94025
Relationship:    Executive Officer X Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Zilkha Nathaniel M.
Street Address 1 Street Address 2
c/o Kohlberg Kravis Roberts & Co. 2800 Sand Hill Road, Suite 200
City State/Province/Country ZIP/PostalCode
Menlo Park CA 94025
Relationship:    Executive Officer X Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Enright Patrick G.
Street Address 1 Street Address 2
c/o Longitude Capital 800 El Camino Real, Suite 220
City State/Province/Country ZIP/PostalCode
Menlo Park CA 94025
Relationship:    Executive Officer X Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
O'Keefe Kenneth W.
Street Address 1 Street Address 2
c/o Beecken Petty O'Keefe & Company, LLC 131 South Dearborn Street, Suite 2800
City State/Province/Country ZIP/PostalCode
Chicago IL 60603
Relationship:    Executive Officer X Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Tananbaum James B.
Street Address 1 Street Address 2
c/o Prospect Venture Partners 435 Tasso Street, Suite 200
City State/Province/Country ZIP/PostalCode
Palo Alto CA 94301
Relationship:    Executive Officer X Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Sebulsky Alan M.
Street Address 1 Street Address 2
c/o Apothecary Capital LLC 1 North Wacker Drive, Suite 3950
City State/Province/Country ZIP/PostalCode
Chicago IL 60606
Relationship:    Executive Officer X Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Cressey Bryan C.
Street Address 1 Street Address 2
c/o Thoma Cressey Bravo, Inc. Sears Tower, 92nd Fl., 22 S. Wacker Dr.
City State/Province/Country ZIP/PostalCode
Chicago IL 60606
Relationship:    Executive Officer X Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Gamble Carol A.
Street Address 1 Street Address 2
c/o Jazz Pharmaceuticals, Inc. 3180 Porter Drive
City State/Province/Country ZIP/PostalCode
Palo Alto CA 94304
Relationship: X Executive Officer    Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Wissel Janne L.T.
Street Address 1 Street Address 2
c/o Jazz Pharmaceuticals, Inc. 3180 Porter Drive
City State/Province/Country ZIP/PostalCode
Palo Alto CA 94304
Relationship: X Executive Officer    Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Colligan Joan E.
Street Address 1 Street Address 2
c/o Jazz Pharmaceuticals, Inc. 3180 Porter Drive
City State/Province/Country ZIP/PostalCode
Palo Alto CA 94304
Relationship: X Executive Officer    Director    Promoter

Clarification of Response (if Necessary):


4. Industry Group

   Agriculture
Banking & Financial Services
   Commercial Banking
   Insurance
   Investing
   Investment Banking
   Pooled Investment Fund
Is the issuer registered as
an investment company under
the Investment Company
Act of 1940?
   Yes    No
   Other Banking & Financial Services
   Business Services
Energy
   Coal Mining
   Electric Utilities
   Energy Conservation
   Environmental Services
   Oil & Gas
   Other Energy
Health Care
   Biotechnology
   Health Insurance
   Hospitals & Physicians
X Pharmaceuticals
   Other Health Care
   Manufacturing
Real Estate
   Commercial
   Construction
   REITS & Finance
   Residential
   Other Real Estate
  
Retailing
  
Restaurants
Technology
   Computers
   Telecommunications
   Other Technology
Travel
   Airlines & Airports
   Lodging & Conventions
   Tourism & Travel Services
   Other Travel
  
Other

5. Issuer Size

Revenue Range OR Aggregate Net Asset Value Range
   No Revenues    No Aggregate Net Asset Value
   $1 - $1,000,000    $1 - $5,000,000
   $1,000,001 - $5,000,000    $5,000,001 - $25,000,000
   $5,000,001 - $25,000,000    $25,000,001 - $50,000,000
   $25,000,001 - $100,000,000    $50,000,001 - $100,000,000
   Over $100,000,000    Over $100,000,000
X Decline to Disclose    Decline to Disclose
   Not Applicable    Not Applicable

6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)

   Rule 504(b)(1) (not (i), (ii) or (iii))    Rule 505
   Rule 504 (b)(1)(i) X Rule 506
   Rule 504 (b)(1)(ii)    Securities Act Section 4(5)
   Rule 504 (b)(1)(iii)    Investment Company Act Section 3(c)
   Section 3(c)(1)    Section 3(c)(9)  
   Section 3(c)(2)    Section 3(c)(10)
   Section 3(c)(3)    Section 3(c)(11)
   Section 3(c)(4)    Section 3(c)(12)
   Section 3(c)(5)    Section 3(c)(13)
   Section 3(c)(6)    Section 3(c)(14)
   Section 3(c)(7)

7. Type of Filing

   New Notice Date of First Sale 2008-03-14    First Sale Yet to Occur
X Amendment

8. Duration of Offering

Does the Issuer intend this offering to last more than one year?
   Yes X No

9. Type(s) of Securities Offered (select all that apply)

   Equity    Pooled Investment Fund Interests
X Debt    Tenant-in-Common Securities
X Option, Warrant or Other Right to Acquire Another Security    Mineral Property Securities
X Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security X Other (describe)
Offering of $120.0 million principal amount of Senior Secured Notes ("Notes"), warrants to purchase 562,192 shares of Common Stock ("Warrants") and the underlying shares of Common Stock issuable upon exercise of Warrants.

10. Business Combination Transaction

Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer?
   Yes X No

Clarification of Response (if Necessary):

11. Minimum Investment

Minimum investment accepted from any outside investor $0 USD

12. Sales Compensation

Recipient
Recipient CRD Number X None
(Associated) Broker or Dealer X None
(Associated) Broker or Dealer CRD Number X None
Street Address 1 Street Address 2
City State/Province/Country ZIP/Postal Code
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US

13. Offering and Sales Amounts

Total Offering Amount $125,250,873 USD
or    Indefinite
Total Amount Sold $120,000,000 USD
Total Remaining to be Sold $5,250,873 USD
or    Indefinite

Clarification of Response (if Necessary):

Item 13(a) represents the principal amount of the Notes sold on 3/14/08 and the current aggregate exercise price of the related Warrants issued on 3/14/08. On 11/10/09, the per share exercise price of the Warrants was reduced from $14.23 to $9.34.

14. Investors

  
Select if securities in the offering have been or may be sold to persons who do not qualify as accredited investors, and enter the number of such non-accredited investors who already have invested in the offering.
Regardless of whether securities in the offering have been or may be sold to persons who do not qualify as accredited investors, enter the total number of investors who already have invested in the offering:
12

15. Sales Commissions & Finder's Fees Expenses

Provide separately the amounts of sales commissions and finders fees expenses, if any. If the amount of an expenditure is not known, provide an estimate and check the box next to the amount.

Sales Commissions $0 USD
   Estimate
Finders' Fees $0 USD
   Estimate

Clarification of Response (if Necessary):

16. Use of Proceeds

Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. If the amount is unknown, provide an estimate and check the box next to the amount.

$0 USD
   Estimate

Clarification of Response (if Necessary):

Signature and Submission

Please verify the information you have entered and review the Terms of Submission below before signing and clicking SUBMIT below to file this notice.

Terms of Submission

In submitting this notice, each issuer named above is:
  • Notifying the SEC and/or each State in which this notice is filed of the offering of securities described and undertaking to furnish them, upon written request, in the accordance with applicable law, the information furnished to offerees.*
  • Irrevocably appointing each of the Secretary of the SEC and, the Securities Administrator or other legally designated officer of the State in which the issuer maintains its principal place of business and any State in which this notice is filed, as its agents for service of process, and agreeing that these persons may accept service on its behalf, of any notice, process or pleading, and further agreeing that such service may be made by registered or certified mail, in any Federal or state action, administrative proceeding, or arbitration brought against the issuer in any place subject to the jurisdiction of the United States, if the action, proceeding or arbitration (a) arises out of any activity in connection with the offering of securities that is the subject of this notice, and (b) is founded, directly or indirectly, upon the provisions of:  (i) the Securities Act of 1933, the Securities Exchange Act of 1934, the Trust Indenture Act of 1939, the Investment Company Act of 1940, or the Investment Advisers Act of 1940, or any rule or regulation under any of these statutes, or (ii) the laws of the State in which the issuer maintains its principal place of business or any State in which this notice is filed.
  • Certifying that, if the issuer is claiming a Rule 505 exemption, the issuer is not disqualified from relying on Rule 505 for one of the reasons stated in Rule 505(b)(2)(iii).

Each Issuer identified above has read this notice, knows the contents to be true, and has duly caused this notice to be signed on its behalf by the undersigned duly authorized person.

For signature, type in the signer's name or other letters or characters adopted or authorized as the signer's signature.

Issuer Signature Name of Signer Title Date
JAZZ PHARMACEUTICALS INC /s/ Carol A. Gamble Carol A. Gamble Senior Vice President, General Counsel and Secretary 2009-11-25

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.

* This undertaking does not affect any limits Section 102(a) of the National Securities Markets Improvement Act of 1996 ("NSMIA") [Pub. L. No. 104-290, 110 Stat. 3416 (Oct. 11, 1996)] imposes on the ability of States to require information. As a result, if the securities that are the subject of this Form D are "covered securities" for purposes of NSMIA, whether in all instances or due to the nature of the offering that is the subject of this Form D, States cannot routinely require offering materials under this undertaking or otherwise and can require offering materials only to the extent NSMIA permits them to do so under NSMIA's preservation of their anti-fraud authority.