0001209191-20-037736.txt : 20200618 0001209191-20-037736.hdr.sgml : 20200618 20200618212518 ACCESSION NUMBER: 0001209191-20-037736 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20200618 FILED AS OF DATE: 20200618 DATE AS OF CHANGE: 20200618 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jerel Davis CENTRAL INDEX KEY: 0001745958 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39335 FILM NUMBER: 20974064 BUSINESS ADDRESS: STREET 1: ONE SANSOME STREET, SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 BUSINESS PHONE: 415-801-8100 MAIL ADDRESS: STREET 1: ONE SANSOME STREET, SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Repare Therapeutics Inc. CENTRAL INDEX KEY: 0001808158 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 000000000 STATE OF INCORPORATION: Z4 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 7210 FREDERICK-BANTING, SUITE 100 CITY: ST-LAURENT STATE: A8 ZIP: H4S 2A1 BUSINESS PHONE: (857) 412-7018 MAIL ADDRESS: STREET 1: 7210 FREDERICK-BANTING, SUITE 100 CITY: ST-LAURENT STATE: A8 ZIP: H4S 2A1 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2020-06-18 0 0001808158 Repare Therapeutics Inc. RPTX 0001745958 Jerel Davis C/O REPARE THERAPEUTICS INC. 7210 FREDERICK-BANTING, SUITE 100 ST-LAURENT A8 QUEBEC, CANADA 1 0 0 0 Common Shares 651462 I See Footnote Common Shares 49580 I See Footnote Common Shares 21692 I See Footnote Common Shares 19596 I See Footnote Class A Preferred Shares Common Shares 2054198 I See Footnote Class A Preferred Shares Common Shares 156335 I See Footnote Class A Preferred Shares Common Shares 68398 I See Footnote Class A Preferred Shares Common Shares 61791 I See Footnote Class A Preferred Shares Common Shares 2443883 I See Footnote Class B Preferred Shares Common Shares 111361 I See Footnote Class B Preferred Shares Common Shares 8475 I See Footnote Class B Preferred Shares Common Shares 3708 I See Footnote Class B Preferred Shares Common Shares 3350 I See Footnote Class B Preferred Shares Common Shares 875568 I See Footnote Class B Preferred Shares Common Shares 458282 I See Footnote The securities are held by Versant Venture Capital V, L.P. ("VVC V"). The Reporting Person is a managing member of the general partner of VVC V, but disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein, if any. The securities are held by Versant Venture Capital V (Canada) LP ("VVC V (Canada)"). The Reporting Person is a director of the ultimate general partner of VVC V (Canada), but disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein, if any. The securities are held by Versant Ophthalmic Affiliates Fund I, L.P. ("VOAF I"). The Reporting Person is a managing member of the general partner of VOAF I, but disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein, if any. The securities are held by Versant Affiliates Fund V, L.P. ("VAF V"). The Reporting Person is a managing member of the general partner of VAF V, but disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein, if any. Each Class A Preferred Share and Class B Preferred Share is convertible at any time, at the holder's election, into Common Shares, on a one-for-one basis, has no expiration date and will convert into Common Shares upon the closing of the Issuer's initial public offering. The securities are held by Versant Venture Capital VI, L.P. ("VVC VI"). The Reporting Person is a managing member of the ultimate general partner of VVC VI, but disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein, if any. The securities are held by Versant Vantage I, L.P. ("VV I"). The Reporting Person is a managing member of the ultimate general partner of VV I, but disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein, if any. /s/ Steve Forte, Attorney-in-Fact 2020-06-18 EX-24.3_923402 2 poa.txt POA DOCUMENT Exhibit 24 POWER OF ATTORNEY (For Executing Form ID and Forms 3, 4 and 5) Know all by these presents, that the undersigned hereby constitutes and appoints each of Lloyd M. Segal and Steve Forte of Repare Therapeutics Inc. (the "Company") and Divakar Gupta, Courtney Thorne, Trey Reilly and Jason Minio of Cooley LLP, signing individually, the undersigned's true and lawful attorneys-in fact and agents to: (1) Prepare, execute in the undersigned's name and on the undersigned's behalf, and submit to the Securities and Exchange Commission (the "SEC"), a Form ID and Forms 3, 4 and 5 (including amendments thereto and joint filing agreements in connection therewith) in accordance with Section 16 of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), and the rules thereunder, in the undersigned's capacity as an officer, director or beneficial owner of more than 10% of a registered class of securities of the Company; (2) Do and perform any and all acts for and on behalf of the undersigned that may be necessary or desirable to prepare and execute any such Form ID and Forms 3, 4 or 5 (including amendments thereto and joint filing agreements in connection therewith) and file such forms with the SEC and any stock exchange, self-regulatory association or any similar authority; and (3) Take any other action of any type whatsoever in connection with the foregoing that, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required of the undersigned, it being understood that the documents executed by the 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 the attorney-in-fact may approve in the attorney-in-fact's discretion. The undersigned hereby grants to each such attorney in fact 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, and their substitutes, 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 of the Exchange Act. This Power of Attorney shall remain in full force and effect until the earliest to occur of (a) the undersigned is no longer required to file Forms 3, 4 and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, (b) revocation by the undersigned in a signed writing delivered to the Company and the foregoing attorneys-in fact or (c) as to any attorney-in-fact individually, until such attorney-in-fact is no longer employed by the Company or employed by or a partner at Cooley LLP or another law firm representing the Company, as applicable. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of the date written below. Date: 6/15/2020 Jerel Davis, Ph.D.