0001209191-17-064531.txt : 20171207 0001209191-17-064531.hdr.sgml : 20171207 20171207181650 ACCESSION NUMBER: 0001209191-17-064531 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20171207 FILED AS OF DATE: 20171207 DATE AS OF CHANGE: 20171207 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FLATLEY JAY T CENTRAL INDEX KEY: 0001189130 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38311 FILM NUMBER: 171245735 MAIL ADDRESS: STREET 1: 9885 TOWNE CENTRE DR CITY: SAN DIEGO STATE: CA ZIP: 92121 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Denali Therapeutics Inc. CENTRAL INDEX KEY: 0001714899 STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836] IRS NUMBER: 463872213 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 151 OYSTER POINT BLVD. STREET 2: 2ND FLOOR CITY: SOUTH SAN FRANCISCO STATE: CA ZIP: 94080 BUSINESS PHONE: (650) 866-8548 MAIL ADDRESS: STREET 1: 151 OYSTER POINT BLVD. STREET 2: 2ND FLOOR CITY: SOUTH SAN FRANCISCO STATE: CA ZIP: 94080 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2017-12-07 0 0001714899 Denali Therapeutics Inc. DNLI 0001189130 FLATLEY JAY T C/O DENALI THERAPEUTICS INC. 151 OYSTER POINT BOULEVARD, SECOND FLOOR SOUTH SAN FRANCISCO CA 94080 1 0 0 0 Common Stock 75000 D Series A-1 Preferred Stock Common Stock 250000 I See footnote The Series A-1 Preferred Stock shall automatically convert into shares of Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of Common Stock and has no expiration date. The shares are held of record by The Flatley Family Trust, for which the Reporting Person serves as a trustee. Exhibit 24 - Power of Attorney /s/ Tyler Nielsen, by power of attorney 2017-12-07 EX-24.3_755855 2 poa.txt POA DOCUMENT POWER OF ATTORNEY The undersigned, as a Section 16 reporting person of Denali Therapeutics Inc. (the "Company"), hereby constitutes and appoints Ryan J. Watts, Steve E. Krognes, Alexander Schuth and Tyler Nielsen, and each of them, 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 Securities and Exchange Commission (the "SEC") a Form ID, including amendments thereto, and any other documents necessary or appropriate to obtain EDGAR 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. complete and execute Forms 3, 4 and 5 and other forms and all amendments thereto as such attorney-in-fact shall in his discretion determine to be required or advisable pursuant to Section 16 of the Securities Exchange Act of 1934 (as amended) and the rules and regulations promulgated thereunder, or any successor laws and regulations, as a consequence of the undersigned's ownership, acquisition or disposition of securities of the Company; and 3. do all acts necessary in order to file such forms with the SEC, any securities exchange or national association, the Company and such other person or agency as the attorneys-in-fact shall deem appropriate. The undersigned hereby ratifies and confirms all that said attorneys-in-fact and agents shall do or cause to be done by virtue hereof. 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 (as amended). 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 Company and the foregoing attorneys-in-fact. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 27th day of November, 2017. Signature: /s/ Jay Flatley Print Name: Jay Flatley