0001209191-13-045506.txt : 20130924
0001209191-13-045506.hdr.sgml : 20130924
20130924181545
ACCESSION NUMBER: 0001209191-13-045506
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20130924
FILED AS OF DATE: 20130924
DATE AS OF CHANGE: 20130924
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Evoke Pharma Inc
CENTRAL INDEX KEY: 0001403708
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 208447886
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 12555 HIGH BLUFF DRIVE
STREET 2: SUITE 385
CITY: San Diego
STATE: CA
ZIP: 92130
BUSINESS PHONE: (760) 487-1255
MAIL ADDRESS:
STREET 1: 12555 HIGH BLUFF DRIVE
STREET 2: SUITE 385
CITY: San Diego
STATE: CA
ZIP: 92130
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: GARNER CAM L
CENTRAL INDEX KEY: 0001024007
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36075
FILM NUMBER: 131113030
MAIL ADDRESS:
STREET 1: PO BOX 675866
CITY: RANCHO SANTE FE
STATE: CA
ZIP: 92067
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2013-09-24
0
0001403708
Evoke Pharma Inc
EVOK
0001024007
GARNER CAM L
C/O EVOKE PHARMA, INC.
12555 HIGH BLUFF DRIVE, SUITE 385
SAN DIEGO
CA
92130
1
0
0
0
Common Stock
360000
I
See footnote
Series A Preferred Stock
Common Stock
15605
I
See footnote
Includes (a) 320,000 shares held by Garner Investments L.L.C., of which Mr. Garner is the managing member, (b) 20,000 shares held by the Anna Berenice Garner Irrevocable Trust dtd 8/13/2007, of which Mr. Garner is a trustee and (c) 20,000 shares held by the Lee Adair Garner Irrevocable Trust dtd 8/13/2007, of which Mr. Garner is a trustee.
The Series A Convertible Preferred Stock has no expiration date, is convertible at any time, in whole or in part, at the election of the holder, and will automatically convert immediately prior to the closing of the Issuer's initial public offering at a conversion ratio of one share of Common Stock for every five shares of Series A Convertible Preferred Stock, rounded down to the next whole number, for no additional consideration.
The shares are held by Garner Investments L.L.C., of which Mr. Garner is the managing member.
/s/ Matthew J. D'Onofrio, Attorney-in-fact for Cam L. Garner
2013-09-24
EX-24.3_488736
2
poa.txt
POA DOCUMENT
LIMITED POWER OF ATTORNEY FOR
SECTION 16 REPORTING OBLIGATIONS
Know all by these presents, that the undersigned hereby constitutes and
appoints each of David A. Gonyer, R.Ph. and Matthew J. D'Onofrio signing singly,
with full power of substitution, as the undersigned's true and lawful
attorney-in-fact to:
(1) prepare, execute in the undersigned's name and on the undersigned's
behalf, and submit to the U.S. Securities and Exchange Commission (the "SEC") a
Form ID, including amendments thereto, and any other documents necessary or
appropriate to obtain codes and passwords enabling the undersigned to make
electronic filings with the SEC of reports required by Section 16(a) of the
Securities Exchange Act of 1934 or any rule or regulation of the SEC;
(2) execute for and on behalf of the undersigned, in the undersigned's capacity
as an officer and/or director of Evoke Pharma, Inc. (the "Company") and/or
beneficial owner of more than 10% of the Company's capital stock, Forms 3, 4,
and 5 and any amendments thereto in accordance with Section 16(a) of the
Securities Exchange Act of 1934 and the rules thereunder;
(3) do and perform any and all acts for and on behalf of the undersigned
which may be necessary or desirable to complete and execute any such Form 3, 4,
or 5, complete and execute any amendment or amendments thereto, and timely file
such form with the SEC and any stock exchange or similar authority; and
(4) 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.
The undersigned hereby grants to each such 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. The undersigned acknowledges that the foregoing attorneys-in-fact, in
serving in such capacity at the request of the undersigned, are not assuming,
nor is the Company assuming, any of the undersigned's responsibilities to comply
with Section 16 of the Securities Exchange Act of 1934.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 11th day of September, 2013.
Signature: /s/ Cam L. Garner
Name: Cam L. Garner