FORM D
Notice of Exempt Offering of Securities

UNITED STATES SECURITIES
AND EXCHANGE COMMISSION
Washington, D.C.

OMB APPROVAL
OMB Number: 3235-0076
Estimated Average burden hours per response: 4.0
1. Issuer's Identity
CIK (Filer ID Number)Previous Name(s)Checkbox checkedNoneEntity Type
0001472012
Radio button checkedCorporation
Radio button not checked Limited Partnership
Radio button not checked Limited Liability Company
Radio button not checked General Partnership
Radio button not checked Business Trust
Radio button not checkedOther 
Name of Issuer
 Immunome Inc.
Jurisdiction of Incorporation/Organization
DELAWARE 
Year of Incorporation/Organization
Radio button checkedOver Five Years Ago
Radio button not checkedWithin Last Five Years (Specify Year)
 
Radio button not checkedYet to Be Formed
 
  
  
 
2. Principal Place of Business and Contact Information
Name of Issuer
 Immunome Inc.
Street Address 1Street Address 2
 665 STOCKTON DRIVE
 SUITE 300
CityState/Province/CountryZIP/Postal CodePhone No. of Issuer
 EXTON
 PENNSYLVANIA
 
 19341
 610-321-3700 




3. Related Persons

Last NameFirst NameMiddle Name
Sarma
Purnanand
Street Address 1Street Address 2
 665 Stockton Drive 
 Suite 300
CityState/Province/CountryZIP/Postal Code
 Exton
 PENNSYLVANIA
 19341
 
Relationship:Checkbox checkedExecutive OfficerCheckbox checkedDirectorCheckbox not checkedPromoter
Clarification of Response (if Necessary)
 



Last NameFirst NameMiddle Name
Morin
Michael
J
Street Address 1Street Address 2
 665 Stockton Drive 
 Suite 300
CityState/Province/CountryZIP/Postal Code
 Exton
 PENNSYLVANIA
 19341
 
Relationship:Checkbox checkedExecutive OfficerCheckbox checkedDirectorCheckbox not checkedPromoter
Clarification of Response (if Necessary)
 



Last NameFirst NameMiddle Name
Widlitz
Michael
D
Street Address 1Street Address 2
 665 Stockton Drive 
 Suite 300
CityState/Province/CountryZIP/Postal Code
 Exton
 PENNSYLVANIA
 19341
 
Relationship:Checkbox not checkedExecutive OfficerCheckbox checkedDirectorCheckbox not checkedPromoter
Clarification of Response (if Necessary)
 



Last NameFirst NameMiddle Name
Wagenheim
Philip
R
Street Address 1Street Address 2
 665 Stockton Drive 
 Suite 300
CityState/Province/CountryZIP/Postal Code
 Exton
 PENNSYLVANIA
 19341
 
Relationship:Checkbox not checkedExecutive OfficerCheckbox checkedDirectorCheckbox not checkedPromoter
Clarification of Response (if Necessary)
 



Last NameFirst NameMiddle Name
LaMattina
John
Street Address 1Street Address 2
 665 Stockton Drive 
 Suite 300
CityState/Province/CountryZIP/Postal Code
 Exton
 PENNSYLVANIA
 19341
 
Relationship:Checkbox not checkedExecutive OfficerCheckbox checkedDirectorCheckbox not checkedPromoter
Clarification of Response (if Necessary)
 



Last NameFirst NameMiddle Name
Lefenfeld
Michael
Street Address 1Street Address 2
 665 Stockton Drive 
 Suite 300
CityState/Province/CountryZIP/Postal Code
 Exton
 PENNSYLVANIA
 19341
 
Relationship:Checkbox not checkedExecutive OfficerCheckbox checkedDirectorCheckbox not checkedPromoter
Clarification of Response (if Necessary)
 



Last NameFirst NameMiddle Name
Morris
I
Wistar
Street Address 1Street Address 2
 665 Stockton Drive 
 Suite 300
CityState/Province/CountryZIP/Postal Code
 Exton
 PENNSYLVANIA
 19341
 
Relationship:Checkbox not checkedExecutive OfficerCheckbox checkedDirectorCheckbox not checkedPromoter
Clarification of Response (if Necessary)
 



Last NameFirst NameMiddle Name
Rapoport
Michael
D
Street Address 1Street Address 2
 665 Stockton Drive 
 Suite 300
CityState/Province/CountryZIP/Postal Code
 Exton
 PENNSYLVANIA
 19341
 
Relationship:Checkbox not checkedExecutive OfficerCheckbox checkedDirectorCheckbox not checkedPromoter
Clarification of Response (if Necessary)
 





4. Industry Group
 Radio button not checkedAgriculture
Banking & Financial Services
 Radio button not checked Commercial Banking
 Radio button not checked Insurance
 Radio button not checkedInvesting
 Radio button not checked Investment Banking
 Radio button not checked Pooled Investment Fund

 Radio button not checkedOther Banking & Financial Services
Radio button not checked Business Services
Energy
 Radio button not checked Coal Mining
 Radio button not checked Electric Utilities
 Radio button not checked Energy Conservation
 Radio button not checked Environmental Services
 Radio button not checked Oil & Gas
 Radio button not checked Other Energy
Health Care
 Radio button checked Biotechnology
 Radio button not checked Health Insurance
 Radio button not checked Hospitals & Physicians
 Radio button not checked Pharmaceuticals
 Radio button not checked Other Health Care
   
   
   
  
Radio button not checked Manufacturing
Real Estate
 Radio button not checkedCommercial
 Radio button not checkedConstruction
 Radio button not checkedREITS & Finance
 Radio button not checkedResidential
Radio button not checkedOther Real Estate
Radio button not checked Retailing
Radio button not checkedRestaurants
Technology
Radio button not checked Computers
Radio button not checked Telecommunications
Radio button not checked Other Technology
Travel
Radio button not checked Airlines & Airports
Radio button not checked Lodging & Conventions
Radio button not checked Tourism & Travel Services
Radio button not checked Other Travel
Radio button not checkedOther

  
   
5. Issuer Size
Revenue RangeAggregate Net Asset Value Range
Radio button not checkedNo RevenuesRadio button not checked No Aggregate Net Asset Value
Radio button not checked $1 - $1,000,000Radio button not checked$1 - $5,000,000
Radio button not checked $1,000,001 - $5,000,000Radio button not checked $5,000,001 - $25,000,000
Radio button not checked$5,000,001 - $25,000,000Radio button not checked $25,000,001 - $50,000,000
Radio button not checked$25,000,001 - $100,000,000Radio button not checked $50,000,001 - $100,000,000
Radio button not checked Over $100,000,000Radio button not checked Over $100,000,000
Radio button checked Decline to Disclose Radio button not checkedDecline to Disclose
Radio button not checked Not ApplicableRadio button not checked Not Applicable

 
6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)
Checkbox not checkedRule 504(b)(1) (not (i), (ii)
or (iii))
Checkbox checkedRule 506(b)      
Checkbox not checkedRule 504 (b)(1)(i) Checkbox not checkedRule 506(c)
Checkbox not checkedRule 504 (b)(1)(ii) Checkbox not checkedSecurities Act Section 4(a)(5)
Checkbox not checkedRule 504 (b)(1)(iii)Checkbox not checkedInvestment Company Act Section 3(c)
 
 

7. Type of Filing
Checkbox not checked New Notice Date of First Sale 
2020-06-02
Checkbox not checked First Sale Yet to Occur
Checkbox checked Amendment


 
 
8. Duration of Offering
Does the Issuer intend this offering to last more than one year? Radio button not checked Yes Radio button checked No
 
 
9. Type(s) of Securities Offered (select all that apply)
Checkbox not checkedPooled Investment Fund InterestsCheckbox checkedEquity
Checkbox not checkedTenant-in-Common Securities Checkbox not checkedDebt
Checkbox not checkedMineral Property SecuritiesCheckbox checkedOption, Warrant or Other Right to Acquire Another Security
Checkbox checkedSecurity to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire SecurityCheckbox checkedOther (describe)
Shares of Common Stock Issuable Upon Conversion of Series A Preferred Stock
 
 
10. Business Combination Transaction
Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer? Radio button not checked Yes Radio button checked No
Clarification of Response (if Necessary)
 
 
 
11. Minimum Investment
Minimum investment accepted from any outside investor$
 0
USD

12. Sales Compensation
Recipient Recipient CRD NumberCheckbox not checkedNone
 
 
(Associated) Broker or DealerCheckbox not checkedNone(Associated) Broker or Dealer CRD Number  Checkbox not checkedNone
 
 
Street Address 1Street Address 2
 
 
City State/Province/CountryZIP/Postal Code
 
 
 
State(s) of Solicitation Checkbox not checkedAll States
 



13. Offering and Sales Amounts
 
Total Offering Amount $
11000000
USDCheckbox not checkedIndefinite
Total Amount Sold $
11000000
USD
Total Remaining to be Sold $
0
USDCheckbox not checkedIndefinite
Clarification of Response (if Necessary)
  
 
14. Investors

Checkbox not checkedSelect if securities in the offering have been or may be sold to persons who do not qualify as accredited investors,
Number of such non-accredited investors who already have invested in the offering
   
  Regardless of whether securities in the offering have been or may be sold to persons who do not qualify as accredited investors, enter the total number of investors who already have invested in the offering:
49
 
15. Sales Commissions & Finders’ Fees Expenses
Provide separately the amounts of sales commissions and finders' fees expenses, if any. If the amount of an expenditure is not known, provide an estimate and check the box next to the amount.
Sales Commissions$
0
USDCheckbox not checkedEstimate
Finders' Fees$
0
USDCheckbox not checkedEstimate
Clarification of Response (if Necessary)
 
 

16. Use of Proceeds
Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. If the amount is unknown, provide an estimate and check the box next to the amount.
 $ 
330000
USDCheckbox checkedEstimate
Clarification of Response (if Necessary)
 

Signature and Submission
 
Please verify the information you have entered and review the Terms of Submission below before signing and clicking SUBMIT below to file this notice.
Terms of Submission 
 In submitting this notice, each Issuer named above is: 
 
  • Notifying the SEC and/or each State in which this notice is filed of the offering of securities described and undertaking to furnish them, upon written request, the information furnished to offerees.
  • Irrevocably appointing each of the Secretary of the SEC and, the Securities Administrator or other legally designated officer of the State in which the Issuer maintains its principal place of business and any State in which this notice is filed, as its agents for service of process, and agreeing that these persons may accept service on its behalf, of any notice, process or pleading, and further agreeing that such service may be made by registered or certified mail, in any Federal or state action, administrative proceeding, or arbitration brought against it in any place subject to the jurisdiction of the United States, if the action, proceeding or arbitration (a) arises out of any activity in connection with the offering of securities that is the subject of this notice, and (b) is founded, directly or indirectly, upon the provisions of:  (i) the Securities Act of 1933, the Securities Exchange Act of 1934, the Trust Indenture Act of 1939, the Investment Company Act of 1940, or the Investment Advisers Act of 1940, or any rule or regulation under any of these statutes, or (ii) the laws of the State in which the issuer maintains its principal place of business or any State in which this notice is filed.
  • Certifying that, if the issuer is claiming a Regulation D exemption for the offering, the issuer is not disqualified from relying on Rule 504 or Rule 506 for one of the reasons stated in Rule 504(b)(3) or Rule 506(d).
 
Each Issuer identified above has read this notice, knows the contents to be true, and has duly caused this notice to be signed on its behalf by the undersigned duly authorized person.
For signature, type in the signer's name or other letters or characters adopted or authorized as the signer's signature.
 
IssuerSignatureName of SignerTitleDate
Immunome Inc.Purnanand SarmaPurnanand SarmaCEO2020-06-16