0000899243-15-002855.txt : 20150811 0000899243-15-002855.hdr.sgml : 20150811 20150811173631 ACCESSION NUMBER: 0000899243-15-002855 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20150811 FILED AS OF DATE: 20150811 DATE AS OF CHANGE: 20150811 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Global Blood Therapeutics, Inc. CENTRAL INDEX KEY: 0001629137 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 274825712 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 400 EAST JAMIE COURT, SUITE 101 CITY: SOUTH SAN FRANCISCO STATE: CA ZIP: 94080 BUSINESS PHONE: 650741-7700 MAIL ADDRESS: STREET 1: 400 EAST JAMIE COURT, SUITE 101 CITY: SOUTH SAN FRANCISCO STATE: CA ZIP: 94080 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LOVE TED W CENTRAL INDEX KEY: 0001188919 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37539 FILM NUMBER: 151044922 MAIL ADDRESS: STREET 1: MAST THERAPEUTICS, INC. STREET 2: 12390 EL CAMINO REAL, STE 150 CITY: SAN DIEGO STATE: CA ZIP: 92130 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2015-08-11 0 0001629137 Global Blood Therapeutics, Inc. GBT 0001188919 LOVE TED W C/O GLOBAL BLOOD THERAPEUTICS, INC. 400 EAST JAMIE COURT, SUITE 101 SOUTH SAN FRANCISCO CA 94080 1 1 0 0 See Remarks Common Stock 21428 D Common Stock 714285 D Common Stock 201428 D Common Stock 99285 D Common Stock 99285 D These shares of Common Stock are subject to the Issuer's right or repurchase, which lapses at a rate of 25% on September 4, 2014 and in 12 equal quarterly installments thereafter. These shares of Common Stock are subject to the Issuer's right or repurchase, which lapses at a rate of 25% on June 9, 2015 and in 12 equal quarterly installments thereafter. These shares of Common stock are subject to the Issuer's right of repurchase, which lapses in 16 equal quarterly installments, with the first installment on July 9, 2015. These shares of Common stock are subject to the Issuer's right of repurchase, which lapses upon the achievement of specified clinical and regulatory milestones within a specified period of time. These shares of Common Stock are subject to the Issuer's right of repurchase, which lapses with respect to all of the underlying shares upon the achievement of specified market capitalization of the Issuer. Chief Executive Officer and President Exhibit List: Exhibit 24.1 - Power of Attorney /s/ John Schembri, attorney-in-fact 2015-08-11 EX-24.1 2 attachment1.htm EX-24.1 DOCUMENT

                            LIMITED POWER OF ATTORNEY

        The undersigned hereby constitutes and appoints each of John Schembri
and Matt Krause, signing singly, and with full power of substitution, 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 Global Blood
Therapeutics, Inc. (the "Company"), from time to time the following U.S.
Securities and Exchange Commission ("SEC") forms: (i) Form ID, including any
attached documents, to effect the assignment of codes to the undersigned to be
used in the transmission of information to the SEC using the EDGAR System; (ii)
Form 3, Initial Statement of Beneficial Ownership of Securities, including any
attached documents; (iii) Form 4, Statement of Changes in Beneficial Ownership
of Securities, including any attached documents; (iv) Form 5, Annual Statement
of Beneficial Ownership of Securities in accordance with Section 16(a) of the
Securities Exchange Act of 1934, as amended, and the rules thereunder, including
any attached documents; (v) Schedule 13D and (vi) amendments of each thereof, in
accordance with the Securities Exchange Act of 1934, as amended, and the rules
thereunder, including any attached documents;

        (2)    do and perform any and all acts for and on behalf of the
undersigned which may be necessary or desirable to complete and execute any such
Form 3, 4 or 5, Schedule 13D or any amendment(s) thereto, and timely file such
form(s) with the SEC and any securities exchange, national association 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 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, acting
singly, 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
the undersigned 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. The undersigned acknowledges that the
foregoing attorneys-in-fact, in serving in such capacity at the request of the
undersigned, are not assuming, nor is the Company assuming, any of the
undersigned's responsibilities to comply with Section 16 or Regulation 13D-G of
the Securities Exchange Act of 1934, as amended. The undersigned hereby agrees
to indemnify the attorneys-in-fact and the Company from and against any demand,
damage, loss, cost or expense arising from any false or misleading information
provided by the undersigned to the attorneys-in-fact.

        This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file such forms 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. This Power of Attorney supersedes any prior power
of attorney in connection with the undersigned's capacity as an officer and/or
director of the Company. This Power of Attorney shall expire as to any
individual attorney-in-fact if such attorney-in-fact ceases to be an executive
officer of, or legal counsel to the Company.

        IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed as of August 7, 2015.


                                       /s/ Ted W. Love, M.D.
                                       -----------------------------------------
                                       Ted W. Love, M.D.