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*
601 UNION STREET, SUITE 3200 |
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(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 01/25/2017
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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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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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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 |
Series B Preferred Stock |
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Common Stock |
1,428,571 |
0 |
D
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Series C Preferred Stock |
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Common Stock |
604,055 |
0 |
D
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Series C-1 Preferred Stock |
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Common Stock |
195,751 |
0 |
D
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Series D Preferred Stock |
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Common Stock |
733,740 |
0 |
I |
See footnote
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Series D Preferred Stock |
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Common Stock |
209,095 |
0 |
I |
See footnote
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Warrant to Purchase Series C Preferred Stock |
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11/04/2018 |
Series C Preferred Stock
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117,235 |
4.55 |
D
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1. Name and Address of Reporting Person*
601 UNION STREET, SUITE 3200 |
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(Street)
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1. Name and Address of Reporting Person*
601 UNION STREET, SUITE 3200 |
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(Street)
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1. Name and Address of Reporting Person*
601 UNION STREET, SUITE 3200 |
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(Street)
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1. Name and Address of Reporting Person*
601 UNION STREET, SUITE 3200 |
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(Street)
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1. Name and Address of Reporting Person*
601 UNION STREET, SUITE 3200 |
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(Street)
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1. Name and Address of Reporting Person*
601 UNION STREET, SUITE 3200 |
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(Street)
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1. Name and Address of Reporting Person*
601 UNION STREET, SUITE 3200 |
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(Street)
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Explanation of Responses: |
Remarks: |
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/s/ Frazier Healthcare V, L.P. by Steve R. Bailey,
Attorney-in-Fact |
01/25/2017 |
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/s/ FHM V, L.P. by Steve R. Bailey, Attorney-in-Fact |
01/25/2017 |
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/s/ FHM V, L.L.C. by Steve R. Bailey, Attorney-in-Fact |
01/25/2017 |
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/s/ Alan Frazier by Steve R. Bailey, Attorney-in-Fact |
01/25/2017 |
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/s/ Nader Naini by Steve R. Bailey, Attorney-in-Fact |
01/25/2017 |
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/s/ Nathan Every by Steve R. Bailey, Attorney-in-Fact |
01/25/2017 |
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/s/ Patrick Heron by Steve R. Bailey, Attorney-in-Fact |
01/25/2017 |
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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. |
KNOW ALL BY THESE PRESENTS, that each person whose signature appears below hereby
constitutes and appoints Steve R. Bailey with full power to act singly, his true
and lawful attorney-in-fact, with full power of substitution, to: (i) sign any
and all instruments, certificates and documents that may be necessary, desirable
or appropriate to be executed on behalf of himself as an individual or in his
capacity as a general partner of any partnership or limited liability company,
pursuant to Section 13 or 16 of the Securities Exchange Act of 1934, as amended,
and any and all regulations promulgated thereunder, (ii) file the same (including
any amendments thereto), with all exhibits thereto, and any other documents in
connection therewith, with the Securities and Exchange Commission, and any stock
exchange or similar authority and (iii) take any other action of any type whatsoever
in connection with the foregoing which, in the opinion of such attorney-in-fact,
may be of benefit to, in the best interest of, or legally required by, the
undersigned, it being understood that the documents executed by such attorney-
in-fact on behalf of the undersigned pursuant to this power of attorney shall be
in such form and shall contain such terms and conditions as such attorney-in-fact
may approve in such attorney-in-fact's discretion, granting unto said attorney-
in-fact full power and authority to do and perform each and every act and thing
necessary, desirable or appropriate. Each of the undersigned hereby grant to the
attorney-in-fact full power and authority to do and perform any and every act and
thing whatsoever requisite, necessary or proper to be done in the exercise of any
of the rights and powers herein granted, as fully to all intents and purposes as
the undersigned might or could do if personally present with full power of
substitution or revocation, hereby ratifying and confirming all that such
attorney-in-fact or such attorney-in-fact's substitute or substitutes, shall
lawfully do or cause to be done by virtue of this power of attorney and the
rights and powers herein granted.
This power of attorney shall remain in full force and effect until revoked by
the undersigned in a signed writing delivered to the attorney-in-fact.
IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 12th day
of February, 2016.
/s/ Alan Frazier
Alan Frazier
/s/ Nader Naini
Nader Naini
/s/ Patrick Heron
Patrick Heron
/s/ James Topper
James Topper
/s/ Nathan Every
Nathan Every