0001209191-16-133329.txt : 20160719 0001209191-16-133329.hdr.sgml : 20160719 20160719171258 ACCESSION NUMBER: 0001209191-16-133329 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20160719 FILED AS OF DATE: 20160719 DATE AS OF CHANGE: 20160719 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Audentes Therapeutics, Inc. CENTRAL INDEX KEY: 0001628738 STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836] IRS NUMBER: 461606174 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 101 MONTGOMERY STREET, SUITE 2650 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 BUSINESS PHONE: 415-638-6556 MAIL ADDRESS: STREET 1: 101 MONTGOMERY STREET, SUITE 2650 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LANGE LOUIS G CENTRAL INDEX KEY: 0001238401 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37833 FILM NUMBER: 161774027 MAIL ADDRESS: STREET 1: 3172 PORTER DRIVE CITY: PALO ALTO STATE: CA ZIP: 94034 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2016-07-19 0 0001628738 Audentes Therapeutics, Inc. BOLD 0001238401 LANGE LOUIS G C/O AUDENTES THERAPEUTICS, INC. 600 CALIFORNIA STREET, 17TH FLOOR SAN FRANCISCO CA 94108 1 0 0 0 Common Stock 466799 D Common Stock 25678 I By Amygdala Lange Trust Common Stock 8558 I By Lange Minors?Trust Common Stock 73943 I By Asset Management Ventures Fund, L.P. Common Stock 12322 I By Camp Lowell, LLC Series B Preferred Stock Common Stock 9000 D Series B Preferred Stock Common Stock 13400 I By Asset Management Ventures Fund, L.P. Series B Preferred Stock Common Stock 2233 I By Camp Lowell, LLC The reporting person's domestic partner is the trustee of the Amygdala Lange Trust. The reporting person disclaims beneficial ownership of such securities, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of such securities for purposes of Section 16 or for any other purposes. The reporting person's domestic partner is the trustee of the Lange Minors' Trust. The reporting person disclaims beneficial ownership of such securities, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of such securities for purposes of Section 16 or for any other purposes. The reporting person is a general partner of Asset Management Ventures Fund, L.P. ("AMVF L.L.P."), and has shared voting and dispositive power over the shares held by AMVF L.L.P. The reporting person disclaims beneficial ownership over such securities except to the extent of his pecuniary interest therein, and the inclusion of such securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes. The reporting person is the president of Camp Lowell, LLC ("Camp Lowell"), and has sole voting and dispositive power over the shares held by Camp Lowell. The reporting person disclaims beneficial ownership over such securities except to the extent of his pecuniary interest therein, and the inclusion of such securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes. Each share of the issuer's Series B Preferred Stock will automatically convert into 1 share of the issuer's Common Stock immediately upon the closing of the issuer's initial public offering and has no expiration date. /s/ Thomas Soloway as attorney-in-fact for Louis Lange, M.D., Ph.D. 2016-07-19 EX-24.3_667397 2 poa.txt POA DOCUMENT LIMITED POWER OF ATTORNEY FOR SECTION 16 REPORTING OBLIGATIONS The undersigned hereby constitutes and appoints Matthew Patterson and Thomas Soloway, as long as they are providing services to Audentes Therapeutics, Inc., a Delaware corporation (the "Company"), or either 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, 4s and 5s 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, 4s and 5s 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, 4s or 5s (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, 4s and 5s 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 15th day of January, 2016. /s/ LOU LANGE Name: Louis Lange, M.D., Ph.D.