0001209191-20-052025.txt : 20200924
0001209191-20-052025.hdr.sgml : 20200924
20200924193106
ACCESSION NUMBER: 0001209191-20-052025
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20200924
FILED AS OF DATE: 20200924
DATE AS OF CHANGE: 20200924
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SHAFFER CHRISTY L
CENTRAL INDEX KEY: 0001145929
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39538
FILM NUMBER: 201196528
MAIL ADDRESS:
STREET 1: INSPIRE PHARMACEUTICALS, INC.,
STREET 2: 4222 EMPEROR BLVD., STE. 470
CITY: DURHAM
STATE: NC
ZIP: 27703-8466
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: GRAYBUG VISION, INC.
CENTRAL INDEX KEY: 0001534133
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 452120079
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 275 SHORELINE DRIVE, SUITE 450
CITY: REDWOOD CITY
STATE: CA
ZIP: 94065
BUSINESS PHONE: 650-487-2800
MAIL ADDRESS:
STREET 1: 275 SHORELINE DRIVE, SUITE 450
CITY: REDWOOD CITY
STATE: CA
ZIP: 94065
FORMER COMPANY:
FORMER CONFORMED NAME: GRAYBUG, Inc.
DATE OF NAME CHANGE: 20150303
FORMER COMPANY:
FORMER CONFORMED NAME: GRAYBUG LLC
DATE OF NAME CHANGE: 20111102
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2020-09-24
0
0001534133
GRAYBUG VISION, INC.
GRAY
0001145929
SHAFFER CHRISTY L
C/O GRAYBUG VISION, INC.
275 SHORELINE DRIVE, SUITE 450
REDWOOD CITY
CA
94065
1
0
0
0
Series A-2 Preferred Stock
Common Stock
193224
I
See footnote
Series B Preferred Stock
Common Stock
1242120
I
See footnote
Series C Preferred Stock
Common Stock
151146
I
See footnote
Stock Option (Right to Buy)
1.00
2025-02-19
Common Stock
33089
I
See footnote
Stock Option (Right to Buy)
1.00
2025-05-08
Common Stock
24638
I
See footnote
Each share of the Issuer's Series A-2 Preferred Stock, Series B Preferred Stock and Series C Preferred Stock will automatically convert into 1 share of the issuer's Common Stock immediately prior to the closing of the Issuer's initial public offering for no additional consideration and has no expiration date.
These securities are held of record by Hatteras Venture Partners IV SBIC, L.P. ("HVP IV SBIC"). Hatteras Venture Advisors IV SBIC, L.L.C. ("HVA IV SBIC") is the general partner of HVP IV SBIC. The managing members of HVA IV SBIC include: Robert Ingram, Douglas Reed, Clay Thorp, John Crumpler and Kenneth Lee. These managing members share voting and dispositive power over the securities directly held by HVP IV SBIC. The Reporting Person is a partner of Hatteras Venture
Partners and disclaims beneficial ownership of the securities held by HVP IV SBIC except to the extent of her pecuniary interest therein, if any.
The stock options are fully vested.
/s/ Frederic Guerard, as Attorney-in-Fact for Christy Shaffer
2020-09-24
EX-24.3_938663
2
poa.txt
POA DOCUMENT
LIMITED POWER OF ATTORNEY
The undersigned hereby constitutes and appoints Frederic Guerard and Robert S.
Breuil, as long as they are providing services to Graybug Vision, Inc. or its
related entities (the "Company"), or any of them, the undersigned's true and
lawful attorney-in-fact to:
(1) execute for and on behalf of the undersigned, in the undersigned's capacity
as an officer and/or director of the Company, Forms 3, 4 and 5 in accordance
with Section 16(a) of the Securities Exchange Act of 1934, as amended (the
"Exchange Act"), and the rules and regulations thereunder;
(2) do and perform any and all acts for and on behalf of the undersigned that
may be necessary or desirable to complete and execute any such Forms 3, 4 and 5
and timely file such forms with the Securities and Exchange Commission and any
stock exchange or similar authority, if required; and
(3) take any other action of any type whatsoever in connection with the
foregoing that, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required by, the undersigned, it being
understood that the documents executed by such attorney-in-fact on behalf of the
undersigned 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.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform each 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 the undersigned might or
could do if personally present, with full power of substitution and revocation,
hereby ratifying and confirming all that each such attorney-in-fact, or each
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. The undersigned acknowledges that each of the foregoing
attorneys-in-fact, in serving in such capacity at the request of the
undersigned, is not assuming, nor is the Company assuming, any of the
undersigned's responsibilities to comply with Section 16 of the Exchange Act.
The undersigned agrees that each such attorney-in-fact may rely entirely on
information furnished orally or in writing by the undersigned to each such
attorney-in-fact. The undersigned also agrees to indemnify and hold harmless
the Company and each such attorney-in-fact against any losses, claims, damages
or liabilities (or actions in these respects) that arise out of or are based on
any untrue statement or omission of necessary facts in the information provided
by the undersigned to such attorney-in-fact for purposes of executing,
acknowledging, delivering and filing Forms 3, 4 or 5 (including amendments
thereto) and agrees to reimburse the Company and each such attorney-in-fact for
any legal or other expenses reasonably incurred in connection with investigating
or defending against any such loss, claim, damage, liability or action.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4 and 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 8th day of September, 2020.
/s/ Christy Shaffer
Christy Shaffer