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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series A-1A Convertible Preferred Stock | (1) | 04/01/2014 | C | 11,478,652 | (1) | (4) | Common Stock | 690,678 | $ 0 | 0 | I | See footnotes (2) | |||
Series B-1 Convertible Preferred Stock | (1) | 04/01/2014 | C | 6,409,436 | (1) | (4) | Common Stock | 183,126 | $ 0 | 0 | I | See footnotes (2) | |||
Series B-2 Convertible Preferred Stock | (1) | 04/01/2014 | C | 11,893,926 | (1) | (4) | Common Stock | 339,826 | $ 0 | 0 | I | See footnotes (2) | |||
Series B-3 Convertible Preferred Stock | (1) | 04/01/2014 | C | 5,699,111 | (1) | (4) | Common Stock | 162,831 | $ 0 | 0 | I | See footnotes (2) | |||
Series B-1 Warrant | $ 0.1297 (5) | 04/01/2014 | C | 416,361 (5) | (6) | 05/02/2017 | Series B-1 Convertible Preferred Stock | 416,361 (5) | $ 0 | 0 | I | See footnotes (2) | |||
Common Stock Warrant | $ 4.54 (5) | 04/01/2014 | C | 11,896 (5) | (6) | 05/02/2017 | Common Stock | 11,896 (5) | $ 0 | 11,896 | I | See footnotes (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Wu Samuel C/O APPLIED GENETIC TECHNOLOGIES CORP. 11801 RESEARCH DRIVE, SUITE D ALACHUA, FL 32615 |
X | X |
/s/ Hemmie Chang, attorney-in-fact for Samuel Wu | 04/01/2014 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Each share of convertible preferred stock converted automatically into common stock upon the closing of the Issuer's initial public offering, and had no expiration date. |
(2) | Shares are held of record by MedImmune Ventures, Inc. The reporting person is a managing director of MedImmune Ventures, Inc. The reporting person disclaims beneficial ownership of all the shares held by MedImmune Ventures, Inc. and this report shall not be deemed an admission of beneficial ownership of such shares for the purposes of Section 16 or for any other purpose except to the extent of his proportionate pecuniary interest therein. |
(3) | Shares purchased in the Issuer's initial public offering at the initial public offering price of $12.00 per share. |
(4) | Not applicable. |
(5) | Each share of Series B-1 convertible preferred stock automatically converted into shares of common stock upon the closing of the Issuer's initial public offering on a 1-for-35 basis. |
(6) | Warrant was fully exercisable upon original issue. |