0001209191-14-046570.txt : 20140709 0001209191-14-046570.hdr.sgml : 20140709 20140709173740 ACCESSION NUMBER: 0001209191-14-046570 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140708 FILED AS OF DATE: 20140709 DATE AS OF CHANGE: 20140709 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: MITCHELL DANIEL J CENTRAL INDEX KEY: 0001113661 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35642 FILM NUMBER: 14967910 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2014-07-08 0 0001245104 GLOBEIMMUNE INC GBIM 0001113661 MITCHELL DANIEL J C/O SEQUEL LIMITED PARTNERSHIP III 4430 ARAPAHOE AVENUE, SUITE 220 BOULDER CO 80303 1 0 0 0 Common Stock 2014-07-08 4 C 0 6961 0.00 A 6961 I By Sequel Entrepreneurs Fund III, LP Common Stock 2014-07-08 4 C 0 250645 0.00 A 250645 I By Sequel Limited Partnership III Common Stock 2014-07-08 4 P 0 75000 10.00 A 325645 I By Sequel Limited Partnership III Common Stock 2014-07-08 4 P 0 10000 10.00 A 10000 D Series A Convertible Preferred Stock 2014-07-08 4 C 0 36557 0.00 D Common Stock 1162 0 I By Sequel Entrepreneurs Fund III, LP Series A Convertible Preferred Stock 2014-07-08 4 C 0 1315441 0.00 D Common Stock 41904 0 I By Sequel Limited Partnership III Series B Convertible Preferred Stock 2014-07-08 4 C 0 84879 0.00 D Common Stock 2704 0 I By Sequel Entrepreneurs Fund III, LP Series B Convertible Preferred Stock 2014-07-08 4 C 0 3054134 0.00 D Common Stock 97296 0 I By Sequel Limited Partnership III Series C Convertible Preferred Stock 2014-07-08 4 C 0 75318 0.00 D Common Stock 2398 0 I By Sequel Entrepreneurs Fund III, LP Series C Convertible Preferred Stock 2014-07-08 4 C 0 2710122 0.00 D Common Stock 86335 0 I By Sequel Limited Partnership III Series E Convertible Preferred Stock 2014-07-08 4 C 0 21905 0.00 D Common Stock 697 0 I By Sequel Entrepreneurs Fund III, LP Series E Convertible Preferred Stock 2014-07-08 4 C 0 788205 0.00 D Common Stock 25110 0 I By Sequel Limited Partnership III Warrant to Purchase Series B Preferred Stock (right to buy) 2014-07-08 4 C 0 2334 1.338 D Common Stock 2334 0 I By Sequel Entrepreneurs Fund III, LP Warrant to Purchase Series B Preferred Stock (right to buy) 2014-07-08 4 C 0 83988 1.338 D Common Stock 83988 0 I By Sequel Limited Partnership III Warrant to Purchase Series C Preferred Stock (right to buy) 2014-07-08 4 C 0 1860 1.445 D Common Stock 1860 0 I By Sequel Entrepreneurs Fund III, LP Warrant to Purchase Series C Preferred Stock (right to buy) 2014-07-08 4 C 0 66955 1.445 D Common Stock 66955 0 I By Sequel Limited Partnership III Warrant to Purchase Common Stock (right to buy) 42.00 2014-07-08 4 C 0 74 0.00 A Common Stock 74 74 I By Sequel Entrepreneurs Fund III, LP Warrant to Purchase Common Stock (right to buy) 42.00 2014-07-08 4 C 0 2675 0.00 A Common Stock 2675 2675 I By Sequel Limited Partnership III Warrant to Purchase Common Stock (right to buy) 45.36 2014-07-08 4 C 0 59 0.00 A Common Stock 59 59 I By Sequel Entrepreneurs Fund III, LP Warrant to Purchase Common Stock (right to buy) 45.36 2014-07-08 4 C 0 2133 0.00 A Common Stock 2133 2133 I By Sequel Limited Partnership III Represents shares of common stock of the Issuer received upon conversion of shares of Series A Convertible Preferred Stock, Series B Convertible Preferred Stock, Series C Convertible Preferred Stock, and Series E Convertible Stock. Every one share of Series A Convertible Preferred Stock, Series B Convertible Preferred Stock, Series C Convertible Preferred Stock, and Series E Convertible Stock (collectively, the "Convertible Preferred Stock") converted on a 1-for- 31.39 basis into shares of common stock of the Issuer upon the closing of the Issuer's initial public offering. The Convertible Preferred Stock of the Issuer had no expiration and was convertible at any time at the option of the holder. Each one share of Series B Convertible Preferred Stock and Series C Convertible Preferred Stock converted 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 was immediately exercisable at any time at the option of the holder. Represents warrants to purchase shares of common stock of the Issuer following the conversion of the Series B Convertible Preferred Stock and Series C Convertible Preferred Stock on a 1-for-31.39 share basis. The number of shares and price per share reported herein reflects such conversion. The Warrant is immediately exercisable at any time at the option of the holder. The general partner of the Sequel Entrepreneurs Fund III, L.P. and Sequel Limited Partnership III (collectively, the "Sequel Funds") is Sequel Venture Partners III, L.L.C. ("SVP III"). SVP III may be deemed to indirectly beneficially own the shares owned by the Sequel Funds. The Reporting Person is a manager of SVP III and may be deemed to be the indirect beneficial owner of the shares owned by the Sequel Funds. The Reporting Person disclaims beneficial ownership of the shares held by the Sequel Funds, except to the extent of his pecuniary interest arising therein. /s/ Matthew P. Dubofsky, Attorney-in-Fact 2014-07-09