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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 01/25/2017 |
3. Issuer Name and Ticker or Trading Symbol
ANAPTYSBIO INC [ ANAB ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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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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Table I - Non-Derivative Securities Beneficially Owned | |||
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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) | |||||||
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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) | (1) | Common Stock | 1,428,571(1) | (1) | D | |
Series C Preferred Stock | (1) | (1) | Common Stock | 486,820(1) | (1) | D | |
Series C-1 Preferred Stock | (1) | (1) | Common Stock | 312,986(1) | (1) | D | |
Series D Preferred Stock | (1) | (1) | Common Stock | 673,454(1) | (1) | D | |
Series C Preferred Stock Warrant (Right to Buy) | (2) | 11/04/2018 | Common Stock | 117,235(2) | 4.55 | D |
Explanation of Responses: |
1. The Series B Preferred Stock. Series C Preferred Stock, Series C-1 Preferred Stock and Series D Preferred Stock (the "Preferred Stock") has no expiration date and is convertible at any time at the holder's election. Immediately prior to the closing of the Issuer's initial public offering (the "IPO Closing"), the Preferred Stock will automatically convert on a one-for-one basis for no additional consideration into common stock. The number of shares reported on this line item reflects the approximate number of shares of common stock subsequent to the 7-for-1 reverse split of common stock effected by the Issuer on January 13, 2017. |
2. Immediately prior to the IPO Closing, the warrant will become exercisable for shares of common stock. |
Remarks: |
Novo A/S is a Danish limited liability company. The board of directors of Novo A/S (the "Novo Board"), currently comprised of Sten Scheibye, Goran Ando, Jeppe Christiansen, Steen Riisgaard and Per Wold-Olsen, has shared investment and voting control over the securities of the Issuer held by Novo A/S (the "Shares") and may exercise such control only with the support of a majority of the Novo Board. As such, no individual member of the Novo Board is deemed to hold any beneficial ownership or reportable pecuniary interest in the Shares. |
/s/ Peter Haahr, Chief Financial Officer of Novo A/S | 01/25/2017 | |
** 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. |