0001209191-14-046566.txt : 20140709
0001209191-14-046566.hdr.sgml : 20140709
20140709173154
ACCESSION NUMBER: 0001209191-14-046566
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: Torres S. Edward
CENTRAL INDEX KEY: 0001552293
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35642
FILM NUMBER: 14967902
MAIL ADDRESS:
STREET 1: C/O LILLY VENTURES FUND I LLC
STREET 2: 115 W. WASHINGTON ST, STE 1680 SOUTH
CITY: INDIANAPOLIS
STATE: IN
ZIP: 46204
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2014-07-08
0
0001245104
GLOBEIMMUNE INC
GBIM
0001552293
Torres S. Edward
C/O LILLY VENTURES FUND I, LLC
115 W. WASHINGTON ST, S TOWER, STE. 1680
INDIANAPOLIS
IN
46204
1
0
0
0
Common Stock
2014-07-08
4
C
0
182894
0.00
A
182894
I
By Lilly Ventures Fund I, LLC
Common Stock
2014-07-08
4
P
0
85000
10.00
A
267894
I
By Lilly Ventures Fund I, LLC
Series B Convertible Preferred Stock
2014-07-08
4
C
0
3736921
0.00
D
Common Stock
119048
0
I
By Lilly Ventures Fund I, LLC
Series C Convertible Preferred Stock
2014-07-08
4
C
0
1685796
0.00
D
Common Stock
53703
0
I
By Lilly Ventures Fund I, LLC
Series E Convertible Preferred Stock
2014-07-08
4
C
0
318411
0.00
D
Common Stock
10143
0
I
By Lilly Ventures Fund I, LLC
Warrant to Purchase Series C Preferred Stock (right to buy)
2014-07-08
4
C
0
50684
1.445
D
Common Stock
50684
0
I
By Lilly Ventures Fund I, LLC
Warrant to Purchase Common Stock (right to buy)
45.36
2014-07-08
4
C
0
1614
0.00
A
Common Stock
1614
1614
I
By Lilly Ventures Fund I, LLC
Represents shares of common stock of the Issuer received upon conversion of shares of Series B Convertible Preferred Stock, Series C Convertible Preferred Stock, and Series E Convertible Stock.
Every one share of 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 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 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 Reporting Person is a managing director of Lilly Ventures Fund I, LLC ("Lilly Ventures") and may be deemed to be the indirect beneficial owner of the shares owned by Lilly Ventures. The Reporting Person disclaims beneficial ownership of the shares held by Lilly Ventures, except to the extent of his pecuniary interest arising therein.
/s/ Matthew P. Dubofsky, Attorney-in-Fact
2014-07-09