0001209191-14-044786.txt : 20140701
0001209191-14-044786.hdr.sgml : 20140701
20140701180024
ACCESSION NUMBER: 0001209191-14-044786
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20140701
FILED AS OF DATE: 20140701
DATE AS OF CHANGE: 20140701
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: GLOBEIMMUNE INC
CENTRAL INDEX KEY: 0001245104
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 841353925
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1450 INFINITE DRIVE
CITY: LOUISVILLE
STATE: CO
ZIP: 80027
BUSINESS PHONE: 3036252744
MAIL ADDRESS:
STREET 1: 1450 INFINITE DRIVE
CITY: LOUISVILLE
STATE: CO
ZIP: 80027
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: WERNER HAROLD R
CENTRAL INDEX KEY: 0001013603
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35642
FILM NUMBER: 14953744
MAIL ADDRESS:
STREET 1: C/O HEALTHCARE VENTURES LLC
STREET 2: 44 NASSAU STREET
CITY: PRINCETON
STATE: NJ
ZIP: 08542
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Mirabelli Christopher
CENTRAL INDEX KEY: 0001262326
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35642
FILM NUMBER: 14953745
MAIL ADDRESS:
STREET 1: 55 CAMBRIDGE PARKWAY
STREET 2: SUITE 301
CITY: CAMBRIDGE
STATE: MA
ZIP: 02142
FORMER NAME:
FORMER CONFORMED NAME: MIRAELLI CHRISTOPHER
DATE OF NAME CHANGE: 20030904
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LITTLECHILD JOHN W
CENTRAL INDEX KEY: 0001013469
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35642
FILM NUMBER: 14953746
MAIL ADDRESS:
STREET 1: 55 CAMBRIDGE PARKWAY
STREET 2: SUITE 301
CITY: CAMBRIDGE
STATE: MA
ZIP: 02142
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LAWLOR AUGUSTINE
CENTRAL INDEX KEY: 0001262327
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35642
FILM NUMBER: 14953747
MAIL ADDRESS:
STREET 1: 55 CAMBRIDGE PARKWAY
STREET 2: SUITE 301
CITY: CAMBRIDGE
STATE: MA
ZIP: 02142
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: HealthCare Partners VII, L.P.
CENTRAL INDEX KEY: 0001330957
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35642
FILM NUMBER: 14953748
BUSINESS ADDRESS:
STREET 1: 44 NASSAU STREET
CITY: PRINCETON
STATE: NJ
ZIP: 08542
BUSINESS PHONE: 609-430-3913
MAIL ADDRESS:
STREET 1: 44 NASSAU STREET
CITY: PRINCETON
STATE: NJ
ZIP: 08542
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: HEALTHCARE VENTURES VII LP
CENTRAL INDEX KEY: 0001202615
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35642
FILM NUMBER: 14953749
BUSINESS ADDRESS:
STREET 1: 55 CAMBRIDGE PARKWAY
STREET 2: SUITE 301
CITY: CAMBRIDGE
STATE: MA
ZIP: 02142
BUSINESS PHONE: 609-430-3900
MAIL ADDRESS:
STREET 1: 55 CAMBRIDGE PARKWAY
STREET 2: SUITE 301
CITY: CAMBRIDGE
STATE: MA
ZIP: 02142
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: CAVANAUGH JAMES H
CENTRAL INDEX KEY: 0001013473
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0731
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35642
FILM NUMBER: 14953743
MAIL ADDRESS:
STREET 1: 265 HOTHORPE LANE
CITY: VILLANOVA
STATE: PA
ZIP: 19085
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2014-07-01
0
0001245104
GLOBEIMMUNE INC
GBIM
0001202615
HEALTHCARE VENTURES VII LP
47 THORNDIKE STREET
SUITE B1-1
CAMBRIDGE
MA
02141
0
0
1
0
0001330957
HealthCare Partners VII, L.P.
47 THORNDIKE STREET
SUITE B1-1
CAMBRIDGE
MA
02141
0
0
1
0
0001262327
LAWLOR AUGUSTINE
C/O HEALTHCARE VENTURES LLC
47 THORNDIKE STREET, SUITE B1-1
CAMBRIDGE
MA
02141
1
0
1
0
0001013469
LITTLECHILD JOHN W
C/O HEALTHCARE VENTURES LLC
47 THORNDIKE STREET, SUITE B1-1
CAMBRIDGE
MA
02141
0
0
1
0
0001262326
Mirabelli Christopher
C/O HEALTHCARE VENTURES LLC
47 THORNDIKE STREET, SUITE B1-1
CAMBRIDGE
MA
02141
0
0
1
0
0001013603
WERNER HAROLD R
C/O HEALTHCARE VENTURES LLC
47 THORNDIKE STREET, SUITE B1-1
CAMBRIDGE
MA
02141
0
0
1
0
0001013473
CAVANAUGH JAMES H
C/O HEALTHCARE VENTURES LLC
47 THORNDIKE STREET, SUITE B1-1
CAMBRIDGE
MA
02141
0
0
1
0
Series A Convertible Preferred Stock
Common Stock
2528000
I
See Footnote
Series B Convertible Preferred Stock
Common Stock
5904335
I
See Footnote
Series C Convertible Preferred Stock
Common Stock
3879015
I
See Footnote
Series E Convertible Preferred Stock
Common Stock
64809
I
See Footnote
Warrant to Purchase Series B Convertible Preferred Stock
1.338
2015-06-30
Common Stock
162369
I
See Footnote
Warrant to Purchase Series C Convertible Preferred Stock
1.445
2019-05-14
Common Stock
116586
I
See Footnote
Each one share of Series A Convertible Preferred Stock, Series B Convertible Preferred Stock, Series C Convertible Preferred Stock and Series E Convertible Preferred Stock (collectively, the "Convertible Preferred Stock") will automatically convert on a 1-for-31.39 share basis into shares of common stock of the Issuer upon the closing of the Issuer's initial public offering. The number of shares reported in column 3 herein does not reflect such conversion. The Convertible Preferred Stock has no expiration date and is convertible at any time at the option of the holder.
These securities are held of record by HealthCare Ventures VII, L.P. ("HCVVII"). HealthCare Partners VII, L.P. ("HCPVII") is the General Partner of HCVVII. Each of James Cavanaugh, Christopher Mirabelli, Harold Werner, John Littlechild and Augustine Lawlor are general partners of HCPVII and exercise shared voting and investment power with respect to the shares owned by HCVVII. Each of the reporting persons disclaims beneficial ownership of such securities, except to the extent of their proportionate pecuniary interest therein. In addition, Mr. Lawlor is a member of the Board of Directors of the Issuer.
Each one share of Series B Convertible Preferred Stock and Series C Convertible Preferred Stock will automatically convert on a 1-for-31.39 share basis into shares of common stock of the Issuer upon the closing of the Issuer's initial public offering. The number of shares and price per share reported herein does not reflect such conversion. The Warrant is immediately exercisable at any time at the option of the holder.
Exhibit List - Exhibit 24 - Power of Attorney
/s/Jeffrey B. Steinberg, Administrative Partner of HealthCare Ventures VII, L.P.
2014-07-01
Jeffrey B. Steinberg, Administrative Partner of HealthCare Partners VII, L.P.
2014-07-01
Jeffrey B. Steinberg, Attorney-in-Fact for Augustine Lawlor
2014-07-01
Jeffrey B. Steinberg, Attorney-in-Fact for John Littlechild
2014-07-01
Jeffrey B. Steinberg, Attorney-in-Fact for Christopher Mirabelli
2014-07-01
Jeffrey B. Steinberg, Attorney-in-Fact for Harold Werner
2014-07-01
Jeffrey B. Steinberg, Attorney-in-Fact for James Cavanaugh
2014-07-01
EX-24.3_529886
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that each person whose signature appears below
hereby constitutes and appoints Jeffrey B. Steinberg his true and lawful
attorney-in-fact, with full power of substitution, to 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 as a managing directors of
any limited liability company, pursuant to sections 13 and 16 of the Securities
Exchange Act of 1934, as amended (the "Exchange Act"), and any and all
regulations promulgated thereunder, and Rules 144, 144A and 145 under the
Securities Act of 1933, as amended (the "Securities Act"), and to file the same,
with all exhibits thereto, and any other documents in connection therewith, with
the Securities and Exchange Commission, and with any other entity when and if
such is mandated by the Exchange Act, by the Securities Act or by the By-laws of
the National Association of Securities Dealers, Inc., or by the by-laws, rules
or regulations of the Financial Industry Regulatory Authority, granting unto
said attorney-in-fact full power and authority to do and perform each and every
act and thing necessary, desirable or appropriate, fully to all intents and
purposes as he might or could do in person, thereby ratifying and confirming all
that said attorney-in-fact, or his substitutes may lawfully do or cause to be
done by virtue hereof.
This Power of Attorney shall be valid for five (5) years from the date set forth
below.
IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 4th day of
November, 2013.
/s/James H. Cavanaugh, Ph.D.
James H. Cavanaugh, Ph.D.
/s/Christopher Mirabelli, Ph.D.
Christopher Mirabelli, Ph.D.
/s/Harold Werner
Harold Werner
/s/John Littlechild
John Littlechild
/s/Augustine Lawlor
Augustine Lawlor