0000899243-18-009459.txt : 20180404 0000899243-18-009459.hdr.sgml : 20180404 20180404164524 ACCESSION NUMBER: 0000899243-18-009459 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180402 FILED AS OF DATE: 20180404 DATE AS OF CHANGE: 20180404 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SHAH MAHENDRA CENTRAL INDEX KEY: 0001255449 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38433 FILM NUMBER: 18737787 MAIL ADDRESS: STREET 1: 2250 HOLCOMBE BLVD CITY: HOUSTON STATE: TX ZIP: 77030 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Homology Medicines, Inc. CENTRAL INDEX KEY: 0001661998 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 473468154 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 45 WIGGINS AVE. CITY: BEDFORD STATE: MA ZIP: 01730 BUSINESS PHONE: 857-305-1825 MAIL ADDRESS: STREET 1: 45 WIGGINS AVE. CITY: BEDFORD STATE: MA ZIP: 01730 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2018-04-02 0 0001661998 Homology Medicines, Inc. FIXX 0001255449 SHAH MAHENDRA 505 HAMILTON STREET, SUITE 207 PALO ALTO CA 94301 1 0 0 0 Common Stock 2018-04-02 4 C 0 659742 0.00 A 659742 I See footnote Common Stock 2018-04-02 4 A 0 500000 16.00 A 1159742 I See footnote Series B Preferred Stock 2018-04-02 4 C 0 659742 0.00 D Common Stock 659742 0 I See footnote The securities reported herein are held of record by Vivo Panda Fund, L.P. ("Vivo LP"). Vivo Panda, LLC ("Vivo LLC") is the sole general partner of Vivo LP. Mahendra G. Shah, Ph.D., is a managing member of Vivo LLC and has shared voting and investment power over the securities beneficially owned by Vivo LP and may therefore be deemed to have or share beneficial ownership of the securities held directly by Vivo LP. Each of Vivo LLC and Dr. Shah disclaims beneficial ownership of such securities except to the extent of any pecuniary interest therein. Upon closing of the Issuer's initial public offering, each share of preferred stock was automatically converted into one share of the Issuer's common stock. By: /s/ Bradford Smith, Attorney-in-Fact for Mahendra G. Shah 2018-04-02