0001437749-15-017267.txt : 20150914
0001437749-15-017267.hdr.sgml : 20150914
20150914195728
ACCESSION NUMBER: 0001437749-15-017267
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20150904
FILED AS OF DATE: 20150914
DATE AS OF CHANGE: 20150914
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Sun BioPharma, Inc.
CENTRAL INDEX KEY: 0001029125
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER INTEGRATED SYSTEMS DESIGN [7373]
IRS NUMBER: 870543922
STATE OF INCORPORATION: UT
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 712 VISTA BLVD #305
CITY: WACONIA
STATE: MN
ZIP: 55387
BUSINESS PHONE: 352-745-7665
MAIL ADDRESS:
STREET 1: 712 VISTA BLVD #305
CITY: WACONIA
STATE: MN
ZIP: 55387
FORMER COMPANY:
FORMER CONFORMED NAME: Cimarron Medical, Inc.
DATE OF NAME CHANGE: 20150602
FORMER COMPANY:
FORMER CONFORMED NAME: CIMARRON SOFTWARE INC
DATE OF NAME CHANGE: 19961217
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: GILBERTSON RYAN RANDALL
CENTRAL INDEX KEY: 0001394821
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-55242
FILM NUMBER: 151106555
MAIL ADDRESS:
STREET 1: 130 LAKE ST. WEST
CITY: WAYZATA
STATE: MN
ZIP: 55391
3
1
rdgdoc.xml
FORM 3
X0206
3
2015-09-04
0
0001029125
Sun BioPharma, Inc.
SNBP
0001394821
GILBERTSON RYAN RANDALL
1000 PARKER'S LAKE ROAD
WAYZATA
MN
55391
1
Common Stock
4170508
D
Stock Option (right to buy)
0.2750
2015-09-04
2023-12-27
Common Stock
1523208
D
Stock Option (right to buy)
0.3175
2015-09-04
2025-03-05
Common Stock
400000
D
Warrants (right to buy)
0.1875
2015-09-04
2023-06-04
Common Stock
800000
D
Convertible Promissory Note (right to buy)
1.1250
2015-09-04
Common Stock
444444
D
Convertible Promissory Note (right to buy)
1.1250
2015-09-04
Common Stock
177776
I
By Total Depth Foundation
Unless earlier terminated pursuant to its terms, the warrants terminate upon the earliest of June 2023, upon a closing of a change of control of Issuer, or immediately prior to a closing of a firm commitment underwritten initial public offering pursuant to an effective registration statement filed under the Securities Act covering the offering and sale of Issuer common stock.
The convertible promissory notes are scheduled to mature and become due and payable on December 27, 2018. The conversion right thereunder has no expiration date.
/s/ Joshua L. Colburn, attorney-in-fact for Ryan R. Gilbertson
2015-09-14
EX-24
2
poagilbertson.txt
POWER OF ATTORNEY
I, Ryan R. Gilbertson, hereby authorize and designate each of W. Morgan
Burns, Joshua L. Colburn and Andrew E. Gustafson signing singly, as my true
and lawful attorney-in-fact to:
(1) execute for and on my behalf, in my capacity as an officer and/or
director of Sun BioPharma, Inc. (the "Company"), Form ID or Forms 3, 4 and 5
in accordance with Section 16(a) of the Securities Exchange Act of 1934 (the
"Exchange Act") and the rules and regulations promulgated thereunder and other
forms or reports on my behalf as may be required to be filed in connection
with my ownership, acquisition, or disposition of securities of the Company,
including Form 144 and Schedule 13D or Schedule 13G;
(2) do and perform any and all acts for and on my behalf which may be
necessary or desirable to complete and execute any such Form ID, Forms 3, 4 or
5, Form 144, Schedule 13D or Schedule 13G and timely file such form with the
Securities and Exchange Commission and any stock exchange or similar
authority; and
(3) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be to my
benefit, in my best interest, or legally required of me, it being understood
that the statements executed by such attorney-in-fact on my behalf pursuant to
this Power of Attorney shall be in such form and shall contain such terms and
conditions as such attorney-in-fact may approve in such attorney-in-fact's
discretion.
I hereby further grant to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and
powers herein granted, as fully to all intents and purposes as I might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be
done by virtue of this Power of Attorney and the rights and powers herein
granted. I hereby acknowledge that the foregoing attorneys-in-fact, in
serving in such capacity at my request, are not assuming, nor is the Company
assuming, any of my responsibilities to comply with Section 16 of the Exchange
Act.
This Power of Attorney shall remain in full force and effect until I am
no longer required to file Form ID or Forms 3, 4 and 5 with respect to my
holdings of and transactions in securities issued by the Company, unless
earlier revoked by me in a signed writing delivered to the foregoing
attorneys-in-fact. Notwithstanding the foregoing, if any such attorney-in-
fact hereafter ceases to be at least one of the following: (i) a partner of
Faegre Baker Daniels LLP or (ii) an employee of Faegre Baker Daniels LLP, then
this Power of Attorney shall be automatically revoked solely as to such
individual, immediately upon such cessation, without any further action on my
part.
I hereby revoke all previous Powers of Attorney that have been granted by
me in connection with my reporting obligations under Section 16 of the
Exchange Act with respect to my holdings of and transactions in securities
issued by the Company.
IN WITNESS WHEREOF, I have caused this Power of Attorney to be duly
executed as of this 11th day of September, 2015.
/s/ Ryan R. Gilbertson