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