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 |
|
1. Name and Address of Reporting Person*
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year) 01/09/2014 |
3. Issuer Name and Ticker or Trading Symbol
GLYCOMIMETICS INC [ GLYC ] |
|||||||||||||
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
5. If Amendment, Date of Original Filed
(Month/Day/Year) |
||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
|
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) |
Common Stock | 10,732 | I | By Spouse(1) |
Common Stock | 116,229 | I | By Funds(2)(3) |
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 | ||||
Stock Option (right to buy) | (4) | 01/04/2021 | Common Stock | 1,562(5) | $1.12(5) | D | |
Series A-1 Preferred Stock | (6) | (6) | Common Stock | 11,936 | (6) | I | By Spouse(1) |
Series A-1 Preferred Stock | (6) | (6) | Common Stock | 337,579 | (6) | I | By Funds(3)(7) |
Warrant to Purchase Common Stock (right to buy) | 12/09/2005 | 12/09/2015 | Common Stock | 5,133(5) | $0.33(5) | I | By Funds(3)(8) |
Warrant to Purchase Common Stock (right to buy) | 07/03/2008 | 07/03/2018 | Common Stock | 38,493(5) | $0.33(5) | I | By Funds(3)(9) |
Explanation of Responses: |
1. These shares are held by Claudia Henos, Mr. Henos's spouse. |
2. 114,888 shares are held by Alliance Technology Ventures III, L.P. ("ATV III") and 1,341 shares are held by ATV III Affiliates Fund, L.P. ("ATV Affiliates"). |
3. Mr. Henos is a manager of ATV III Partners, LLC, the general partner of ATV III and ATV Affiliates and shares voting and investment power with respect to the securities held by ATV III and ATV Affiliates. Mr. Henos disclaims beneficial ownership of the securities, except to the extent of his pecuniary interest therein. |
4. The shares underlying this option are fully vested. |
5. The number of underlying shares of common stock and the exercise price reported reflect a 1-for-3.302 reverse stock split of the Issuer's common stock effected on October 25, 2013. |
6. Each share of Series A-1 Preferred Stock is convertible, at any time, at the holder's election, into the Issuer's common stock on a 1-for-3.302 basis. In addition, effective immediately prior to the closing of the Issuer's initial public offering of its common stock, each share of Series A-1 Preferred Stock will automatically convert into approximately 0.3028 shares of the Issuer's common stock. The Series A-1 Preferred Stock has no expiration date. |
7. 334,203 shares are held by ATV III and 3,376 shares are held by ATV Affiliates. |
8. 5,098 shares underlying warrants are held by ATV III and 35 shares underlying warrants are held by ATV Affiliates. |
9. 38,109 shares underlying warrants are held by ATV III and 384 shares underlying warrants are held by ATV Affiliates. |
Remarks: |
Exhibit 24.1 - Power of Attorney |
/s/ Brian F. Leaf, Attorney-in-fact | 01/09/2014 | |
** 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. |