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