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