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