0000904454-11-000631.txt : 20111121 0000904454-11-000631.hdr.sgml : 20111121 20111121210407 ACCESSION NUMBER: 0000904454-11-000631 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111121 FILED AS OF DATE: 20111121 DATE AS OF CHANGE: 20111121 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DP VII ASSOCIATES LP CENTRAL INDEX KEY: 0001372932 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35347 FILM NUMBER: 111220253 BUSINESS ADDRESS: STREET 1: ONE PALMER SQ STREET 2: STE 515 CITY: PRINCETON STATE: NJ ZIP: 08542 MAIL ADDRESS: STREET 1: ONE PALMER SQ STREET 2: STE 515 CITY: PRINCETON STATE: NJ ZIP: 08542 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Clovis Oncology, Inc. CENTRAL INDEX KEY: 0001466301 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 900475355 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2525 28TH STREET STREET 2: SUITE 100 CITY: BOULDER STATE: CO ZIP: 80301 BUSINESS PHONE: (303) 625-5000 MAIL ADDRESS: STREET 1: 2525 28TH STREET STREET 2: SUITE 100 CITY: BOULDER STATE: CO ZIP: 80301 4 1 edgar.xml PRIMARY DOCUMENT X0304 4 2011-11-21 0001466301 Clovis Oncology, Inc. CLVS 0001372932 DP VII ASSOCIATES LP C/O DOMAIN ASSOCIATES, LLC ONE PALMER SQUARE PRINCETON NJ 08542 0 0 1 0 Common Stock 2011-11-21 4 C 0 6979 A 6979 D Common Stiock 2011-11-21 4 C 0 6979 A 13958 D Common Stock 2011-11-21 4 C 0 15106 A 29064 D Common Stock 2011-11-21 4 C 0 6324 A 35388 D Common Stock 2011-11-21 4 P 0 15625 13.00 A 51013 D Series A-1 Preferred Stock 2011-11-21 4 C 0 20240 0 D Common Stock 6979 0 D Series A-2 Preferred Stock 2011-11-21 4 C 0 20240 0 D Common Stock 6979 0 D Series B Preferred Stok 2011-11-21 4 C 0 43809 0 D Common Stock 15106 0 D Convertible Promissory Note 2011-11-21 4 C 0 80229.00 0 D Common Stock 6324 0 D All outstanding shares of the Issuer's preferred stock were automatically converted into Common Stock upon the closing of the Issuer's iniital public offering (the "IPO"), for no additional consideration. The Convertible Promissory Note plus interest accrued thereon through the closing of the IPO, automatically converted into Common Stock upon the closing of the IPO, based on the IPO price of $13.00 per share. /s/Kathleen K. Schoemaker, Managing Member of One Palmer Square Associates VII, LLC, General Partner of DP VII Associates, L.P. 2011-11-21