SEC Form 4 · accession 0001209191-16-119316
Intellia Therapeutics, Inc. · NTLA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owners
Atlas Venture Associates IX, LLC
10% Owner
Atlas Venture Associates IX, L.P.
10% Owner
Atlas Venture Fund IX, L.P.
10% Owner
Period of report
May 11, 2016
Accepted (ET)
May 11, 2016 · 6:59 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 | 611,827 | — | A | 611,827 | D | |
| Common StockF1,F2 | May 11, 2016 | C | 2,463,201 | — | A | 3,075,028 | D | |
| Common StockF1,F2 | May 11, 2016 | C | 862,120 | — | A | 3,937,148 | D | |
| Common StockF1,F2 | May 11, 2016 | C | 492,640 | — | A | 4,429,788 | D |
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 | — | May 11, 2016 | C | 946,237 | D | — | — | Common Stock | 611,827 | 0 | D |
| Series A-1 Preferred StockF2,F1 | — | May 11, 2016 | C | 3,809,524 | D | — | — | Common Stock | 2,463,201 | 0 | D |
| Series A-2 Preferred StockF2,F1 | — | May 11, 2016 | C | 1,333,333 | D | — | — | Common Stock | 862,120 | 0 | D |
| Series B Preferred StockF2,F1 | — | May 11, 2016 | C | 761,905 | D | — | — | Common Stock | 492,640 | 0 | D |
Explanation of responses
- F1Each share of Founder Stock, Series A-1 Preferred Stock, Series A-2 Preferred Stock and Series B Preferred Stock was automatically converted into 0.6465903 of a share of Common Stock upon the closing of the Issuer's initial public offering without payment of further consideration and had no expiration date.
- F2The shares are held directly by Atlas Venture Fund IX, L.P. ("Atlas Venture Fund IX"). The general partner of Atlas Venture Fund IX is Atlas Venture Associates IX, L.P. ("AVA IX LP"). Atlas Venture Associates IX, LLC ("AVA IX LLC") is the general partner of AVA IX LP. Each of AVA IX LP and AVA IX LLC disclaims Section 16 beneficial ownership of the securities held by Atlas Venture Fund IX, except to the extent of its pecuniary interest therein, if any.