SEC Form 4 · accession 0001209191-16-119298
Intellia Therapeutics, Inc. · NTLA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Rachel E. Haurwitz
Director · 10% Owner
Period of report
May 11, 2016
Accepted (ET)
May 11, 2016 · 6:40 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001652130
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2 | May 11, 2016 | C | 174,806 | — | A | 349,612 | I | See Footnote |
| Common StockF3,F2 | May 11, 2016 | C | 5,244,234 | — | A | 5,593,846 | I | See Footnote |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Founder StockF2,F1,F4 | — | May 11, 2016 | C | 270,352 | D | — | — | Common Stock | 174,806 | 0 | I |
| Junior Preferred StockF2,F3,F4 | — | May 11, 2016 | C | 8,110,599 | D | — | — | Common Stock | 5,244,234 | 0 | I |
Explanation of responses
- F1Each share of Founder Stock was automatically converted into 0.6465903 of a share of the Issuer's Common Stock upon the closing of the Issuer's initial public offering without payment of further consideration.
- F2Represents shares held by Caribou Therapeutics Holdco, LLC ("Caribou Holdco"). Caribou Holdco is a wholly-owned subsidiary of Caribou Biosciences, Inc. ("Caribou"). Rachel Haurwitz is a greater than 5% stockholder of Caribou, and the President, Chief Executive Officer and a director of Caribou. Dr. Haurwitz may be deemed to share voting and dispositive power with respect to the shares held by Caribou Holdco. Dr. Haurwitz disclaims beneficial ownership of such shares, except to the extent of her pecuniary interest therein, if any.
- F3Each share of Junior Preferred Stock was automatically converted into 0.6465903 of a share of the Issuer's Common Stock upon the closing of the Issuer's initial public offering without payment of further consideration.
- F4Not applicable.