SEC Form 4 · accession 0001209191-16-118558
Intellia Therapeutics, Inc. · NTLA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jean Francois Formela
Director
Period of report
May 5, 2016
Accepted (ET)
May 9, 2016 · 5:49 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001652130
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (right to buy)F2,F1 | $18.00 | May 5, 2016 | A | 23,529 | A | — | May 4, 2026 | Common Stock | 23,529 | 23,529 | D |
Explanation of responses
- F1This option was granted on May 5, 2016 with respect to 23,529 shares of Common Stock, with 33% vesting on May 5, 2017 and the remaining 67% vesting in 24 substantially equal monthly installments thereafter.
- F2The reporting person is a member of Atlas Venture Associates IX, LLC ("AVA IX LLC") and is obligated to transfer the economic benefit, if any, received upon the sale of the shares issuable upon exercise of the equity grants to Atlas Venture Advisors, L.P. As such, the Reporting Person disclaims beneficial ownership of the securities reported herein for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, except to the extent of his pecuniary interest therein, if any.