0001209191-17-018547.txt : 20170307 0001209191-17-018547.hdr.sgml : 20170307 20170307083500 ACCESSION NUMBER: 0001209191-17-018547 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170303 FILED AS OF DATE: 20170307 DATE AS OF CHANGE: 20170307 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Intellia Therapeutics, Inc. CENTRAL INDEX KEY: 0001652130 STANDARD INDUSTRIAL CLASSIFICATION: IN VITRO & IN VIVO DIAGNOSTIC SUBSTANCES [2835] IRS NUMBER: 364785571 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 40 ERIE STREET STREET 2: SUITE 130 CITY: CAMBRIDGE STATE: MA ZIP: 02139 BUSINESS PHONE: 857-285-6200 MAIL ADDRESS: STREET 1: 40 ERIE STREET STREET 2: SUITE 130 CITY: CAMBRIDGE STATE: MA ZIP: 02139 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Atlas Venture Associates IX, LLC CENTRAL INDEX KEY: 0001671207 STATE OF INCORPORATION: DE FISCAL YEAR END: 1012 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37766 FILM NUMBER: 17670336 BUSINESS ADDRESS: STREET 1: 25 FIRST ST STREET 2: STE 303 CITY: CAMBRIDGE STATE: MA ZIP: 02141 BUSINESS PHONE: 6175882695 MAIL ADDRESS: STREET 1: 25 FIRST ST STREET 2: STE 303 CITY: CAMBRIDGE STATE: MA ZIP: 02141 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Atlas Venture Associates IX, L.P. CENTRAL INDEX KEY: 0001671208 STATE OF INCORPORATION: DE FISCAL YEAR END: 1012 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37766 FILM NUMBER: 17670337 BUSINESS ADDRESS: STREET 1: 25 FIRST ST STREET 2: STE 303 CITY: CAMBRIDGE STATE: MA ZIP: 02141 BUSINESS PHONE: 6175882695 MAIL ADDRESS: STREET 1: 25 FIRST ST STREET 2: STE 303 CITY: CAMBRIDGE STATE: MA ZIP: 02141 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Atlas Venture Fund IX, L.P. CENTRAL INDEX KEY: 0001671219 STATE OF INCORPORATION: DE FISCAL YEAR END: 1012 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37766 FILM NUMBER: 17670338 BUSINESS ADDRESS: STREET 1: 25 FIRST ST STREET 2: STE 303 CITY: CAMBRIDGE STATE: MA ZIP: 02141 BUSINESS PHONE: 6175882695 MAIL ADDRESS: STREET 1: 25 FIRST ST STREET 2: STE 303 CITY: CAMBRIDGE STATE: MA ZIP: 02141 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-03-03 0 0001652130 Intellia Therapeutics, Inc. NTLA 0001671219 Atlas Venture Fund IX, L.P. 25 FIRST STREET, SUITE 303 CAMBRIDGE MA 02141 0 0 1 0 0001671208 Atlas Venture Associates IX, L.P. 25 FIRST STREET, SUITE 303 CAMBRIDGE MA 02141 0 0 1 0 0001671207 Atlas Venture Associates IX, LLC 25 FIRST STREET, SUITE 303 CAMBRIDGE MA 02141 0 0 1 0 Common Stock 2017-03-03 4 J 0 700000 D 3729788 D On March 3, 2017, Atlas Venture Fund IX, L.P. ("Atlas Venture Fund IX") distributed, for no consideration, 700,000 shares of the Issuer's Common Stock pro-rata to its partners, including its limited partners and its general partner, Atlas Venture Associates IX, L.P. ("AVA IX LP"), in accordance with the exemptions afforded by Rule 16a-9 and Rule 16a-13 of the Securities Exchange Act of 1934, as amended (the "Act"). The shares are held directly by Atlas Venture Fund IX. Each of AVA IX LP and Atlas Venture Associates IX, LLC, its general partner ("AVA IX LLC") disclaims Section 16 beneficial ownership of the securities held by Atlas Venture Fund IX, except to the extent of its pecuniary interest therein, if any. Atlas Venture Fund IX, LP By: Atlas Venture Associates IX, LP, its general partner By: Atlas Venture Associate IX, LLC, its general partner By: /s/ Frank Castellucci, General Counsel 2017-03-07 Atlas Venture Associates IX, L.P. By: Atlas Venture Associates IX, LLC, its general partner, By: /s/ Frank Castellucci, General Counsel 2017-03-07 Atlas Venture Associates IX, LLC, By: /s/ Frank Castellucci, General Counsel 2017-03-07