SEC Form 4 · accession 0001209191-16-119321

Intellia Therapeutics, Inc. · NTLA

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

May 11, 2016

Accepted (ET)

May 11, 2016 · 7:01 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 Stock^F1,F2	May 11, 2016	C	611,827	—	A	611,827	I	See Footnote
Common Stock^F1,F2	May 11, 2016	C	2,463,201	—	A	3,075,028	I	See Footnote
Common Stock^F1,F2	May 11, 2016	C	862,120	—	A	3,937,148	I	See Footnote
Common Stock^F1,F2	May 11, 2016	C	492,640	—	A	4,429,788	I	See Footnote

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Founder Stock^F2,F1	—	May 11, 2016	C	946,237	D	—	—	Common Stock	611,827	I
Series A-1 Preferred Stock^F2,F1	—	May 11, 2016	C	3,809,524	D	—	—	Common Stock	2,463,201	I
Series A-2 Preferred Stock^F2,F1	—	May 11, 2016	C	1,333,333	D	—	—	Common Stock	862,120	I
Series B Preferred Stock^F2,F1	—	May 11, 2016	C	761,905	D	—	—	Common Stock	492,640	I

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.
F2Represents shares held 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. Dr. Formela is a member of AVA IX LLC and disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein, if any.