0000904454-11-000623.txt : 20111121
0000904454-11-000623.hdr.sgml : 20111121
20111121205439
ACCESSION NUMBER: 0000904454-11-000623
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20111121
FILED AS OF DATE: 20111121
DATE AS OF CHANGE: 20111121
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Halak Brian K
CENTRAL INDEX KEY: 0001354718
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35347
FILM NUMBER: 111220241
MAIL ADDRESS:
STREET 1: C/O DOMAIN ASSOCIATES
STREET 2: ONE PALMER SQUARE
CITY: PRINCETON
STATE: NJ
ZIP: 08542
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Clovis Oncology, Inc.
CENTRAL INDEX KEY: 0001466301
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 900475355
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2525 28TH STREET
STREET 2: SUITE 100
CITY: BOULDER
STATE: CO
ZIP: 80301
BUSINESS PHONE: (303) 625-5000
MAIL ADDRESS:
STREET 1: 2525 28TH STREET
STREET 2: SUITE 100
CITY: BOULDER
STATE: CO
ZIP: 80301
4
1
edgar.xml
PRIMARY DOCUMENT
X0304
4
2011-11-21
0001466301
Clovis Oncology, Inc.
CLVS
0001354718
Halak Brian K
C/O DOMAIN ASSOCIATES, LLC
ONE PALMER SQUARE
PRINCETON
NJ
08542
0
0
1
0
Common Stock
2011-11-21
4
C
0
409192
A
409192
I
By Domain Partners VII, L.P.
Common Stock
2011-11-21
4
C
0
409192
A
818384
I
By Domain Partners VII, L.P.
Common Stock
2011-11-21
4
C
0
885696
A
1704080
I
By Domain Partners VII, L.P.
Common Stock
2011-11-21
4
C
0
370799
A
2074879
I
By Domain Partners VII, L.P.
Common Stock
2011-11-21
4
P
0
916058
13.00
A
2990937
I
By Domain Partners VII, L.P.
Common Stock
2011-11-21
4
C
0
6979
A
6979
I
By DP VII Associates, L.P.
Common Stock
2011-11-21
4
C
0
6979
A
13958
I
By DP VII Associates, L.P.
Common Stock
2011-11-21
4
C
0
15106
A
29064
I
By DP VII Associates, L.P.
Common Stock
2011-11-21
4
C
0
6324
A
35388
I
By DP VII Associates, L.P.
Common Stock
2011-11-21
4
P
0
15625
13.00
A
51013
I
By DP VII Associates, L.P.
Series A-1 Preferred Stock
2011-11-21
4
C
0
1186657
0
D
Common Stock
409192
0
I
By Domain Partners VII, L.P.
Series A-2 Preferred Stock
2011-11-21
4
C
0
1186657
0
D
Common Stock
409192
0
I
By Domain Partners VII, L.P.
Series B Preferred Stock
2011-11-21
4
C
0
2568521
0
D
Common Stock
885696
0
I
By Domain Partners VII, L.P.
Convertible Promissory Note
2011-11-21
4
C
0
4703771.00
0
D
Common Stock
370799
0
I
By Domain Partners VII, L.P.
Series A-1 Preferred Stock
2011-11-21
4
C
0
20240
0
D
Common Stock
6979
0
I
By DP VII Associates, L.P.
Series A-2 Preferred Stock
2011-11-21
4
C
0
20240
0
D
Common Stock
6979
0
I
By DP VII Associates, L.P.
Series B Preferred Stock
2011-11-21
4
C
0
43809
0
D
Common Stock
15106
0
I
By DP VII Associates, L.P.
Convertible Promissory Note
2011-11-21
4
C
0
80229.00
0
D
Common Stock
6324
0
I
By DP VII Associates, L.P.
All outstanding shares of the Issuer's preferred stock were automatically converted into Common Stock upon the closing of the Issuer's initial public offering (the "IPO"), for no additional consideration.
The Convertible Promissory Note, plus interest accrued thereon through the closing of the IPO, automatically converted into Common Stock upon the closing of the IPO, based on the IPO price of $13.00 per share.
The Reporting Person also indirectly beneficially owns 32,758 shares of Common Stock held by Domain Associates, LLC. The Reporting Person is a Managing Member of One Palmer Square Associates VII, LLC, which is the sole general partner of Domain Partners VII, L.P. and DP VII Associates, L.P. and Domain Associates, LLC. Pursuant to Instruction (4)(b)(iv) of Form 4, the Reporting Person has elected to report as indirectly beneficially owned the entire number of securities beneficially owned by each such entity. The Reporting Person disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his or her pecuniary interest therein and/or that are not actually distributed to him or her.
/s/Kathleen K. Schoemaker, Attorney-in-Fact
2011-11-21