0000899243-20-017704.txt : 20200625 0000899243-20-017704.hdr.sgml : 20200625 20200625200052 ACCESSION NUMBER: 0000899243-20-017704 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20200625 FILED AS OF DATE: 20200625 DATE AS OF CHANGE: 20200625 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Khuong Chau Quang CENTRAL INDEX KEY: 0001609405 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39344 FILM NUMBER: 20990635 MAIL ADDRESS: STREET 1: C/O ORBIMED ADVISORS STREET 2: 601 LEXINGTON AVENUE, 54TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Fusion Pharmaceuticals Inc. CENTRAL INDEX KEY: 0001805890 STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836] IRS NUMBER: 000000000 STATE OF INCORPORATION: Z4 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 270 LONGWOOD ROAD SOUTH CITY: HAMILTON STATE: A6 ZIP: L8P 0A6 BUSINESS PHONE: 289-799-0891 MAIL ADDRESS: STREET 1: 270 LONGWOOD ROAD SOUTH CITY: HAMILTON STATE: A6 ZIP: L8P 0A6 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2020-06-25 0 0001805890 Fusion Pharmaceuticals Inc. FUSN 0001609405 Khuong Chau Quang C/O FUSION PHARMACEUTICALS INC. 270 LONGWOOD ROAD SOUTH HAMILTON A6 L8P 0A6 ONTARIO, CANADA 1 0 0 0 Class B Preferred Shares Common Shares 2224770 I By OrbiMed Private Investments VII, LP Warrants to purchase Class B Preferred Shares 8.10 2020-01-10 2022-01-10 Common Shares 67311 I By OrbiMed Private Investments VII, LP The Class B Preferred Shares are convertible into Common Shares on a one-for-5.339 basis. Upon the closing of the Issuer's initial public offering, the Class B Preferred Shares will convert into the number of Common Shares shown in column 3. The Class B Preferred Shares have no expiration date. These securities are held of record by OrbiMed Private Investments VII, LP ("OPI VII"). OrbiMed Capital GP VII LLC ("GP VII") is the general partner of OPI VII. OrbiMed Advisors LLC ("OrbiMed Advisors") is the managing member of GP VII. By virtue of such relationships, GP VII and OrbiMed Advisors may be deemed to have voting and investment power with respect to the shares held by OPI VII and as a result may be deemed to have beneficial ownership of such shares. The Reporting Person is an employee of OrbiMed Advisors. OrbiMed Advisors exercises investment and voting power through a management committee comprised of Carl L. Gordon, Sven H. Borho, and Jonathan T. Silverstein. Each of GP VII, OrbiMed Advisors, and the Reporting Person disclaims beneficial ownership of the shares held by OPI VII, except to the extent of its or his pecuniary interest therein, if any. Upon the closing of the Issuer's initial public offering, the Warrants to purchase Class B Preferred Shares will become warrants to purchase Common Shares at an exercise price of $8.10 per share. Exhibit 24 - Power of Attorney /s/ Chau Quang Khuong 2020-06-25 EX-24 2 attachment1.htm EX-24 DOCUMENT

                               LIMITED POWER OF ATTORNEY

    The undersigned hereby constitutes and appoints each of John Valliant, John
Crowley, Seo Salimi and Marishka DeToy, signing singly, and with full power of
substitution, the undersigned's true and lawful attorney-in-fact to:

    (1)   execute for and on behalf of the undersigned, in the undersigned's
capacity as officer and/or director of Fusion Pharmaceuticals Inc. (the
"Company"), from time to time the following U.S. Securities and Exchange
Commission ("SEC") forms: (i) Form ID, including any attached documents (such as
Update Passphrase Authentication), to effect the assignment of codes to the
undersigned to be used in the transmission of information to the SEC using the
EDGAR System; (ii) Form 3, Initial Statement of Beneficial Ownership of
Securities, including any attached documents; (iii) Form 4, Statement of Changes
in Beneficial Ownership of Securities, including any attached documents; (iv)
Form 5, Annual Statement of Beneficial Ownership of Securities in accordance
with Section 16(a) of the Securities Exchange Act of 1934, as amended, and the
rules thereunder, including any attached documents; (v) Schedules 13D and 13G;
and (vi) amendments of each thereof, in accordance with the Securities Exchange
Act of 1934, as amended, and the rules thereunder, including any attached
documents;

    (2)   do and perform any and all acts for and on behalf of the undersigned
which may be necessary or desirable to complete and execute any such Form 3, 4
or 5, Schedule 13D or 13G, or any amendment(s) thereto and timely file such
form(s) with the SEC and any securities exchange, national association or
similar authority; and

    (3)   take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required by, the undersigned, it being
understood that the documents executed by such attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as such attorney-in-fact may approve in such
attorney-in-fact's discretion.

    The undersigned hereby grants to each such attorney-in-fact, acting singly,
full power and authority to do and perform any and every act and thing
whatsoever requisite, necessary or proper to be done in the exercise of any of
the rights and powers herein granted, as fully to all intents and purposes as
the undersigned might or could do if personally present, with full power of
substitution or revocation, hereby ratifying and confirming all that such
attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall
lawfully do or cause to be done by virtue of this power of attorney and the
rights and powers herein granted.  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 or Regulation 13D-G of
the Securities Exchange Act of 1934, as amended.  The undersigned hereby agrees
to indemnify the attorneys-in-fact and the Company from and against any demand,
damage, loss, cost or expense arising from any false or misleading information
provided by the undersigned to the attorneys-in-fact.

    This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file such forms 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
foregoing attorneys-in-fact.  This Power of Attorney supersedes any prior power
of attorney in connection with the undersigned's capacity as an officer and/or
director of the Company.  This Power of Attorney shall expire as to any
individual attorney-in-fact if such attorney-in-fact ceases to be an employee
of the Company.

    IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of June 25, 2020.


                                        /s/ Chau Khuong
                                        -------------------------------------
                                        Signature


                                        Chau Khuong
                                        -------------------------------------
                                        Print Name