0001209191-14-023239.txt : 20140326 0001209191-14-023239.hdr.sgml : 20140326 20140326174214 ACCESSION NUMBER: 0001209191-14-023239 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140326 FILED AS OF DATE: 20140326 DATE AS OF CHANGE: 20140326 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: APPLIED GENETIC TECHNOLOGIES CORP CENTRAL INDEX KEY: 0001273636 STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836] IRS NUMBER: 593553710 STATE OF INCORPORATION: DE FISCAL YEAR END: 0630 BUSINESS ADDRESS: STREET 1: 11801 RESEARCH DRIVE STREET 2: SUITE D CITY: ALACHUA STATE: FL ZIP: 32615 BUSINESS PHONE: 386-462-2204 MAIL ADDRESS: STREET 1: 11801 RESEARCH DRIVE STREET 2: SUITE D CITY: ALACHUA STATE: FL ZIP: 32615 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Carroll Jill CENTRAL INDEX KEY: 0001598542 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36370 FILM NUMBER: 14719612 MAIL ADDRESS: STREET 1: C/O APPLIED GENETIC TECHNOLOGIES CORP. STREET 2: 11801 RESEARCH DRIVE, SUITE D CITY: ALACHUA STATE: FL ZIP: 32615 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2014-03-26 0 0001273636 APPLIED GENETIC TECHNOLOGIES CORP AGTC 0001598542 Carroll Jill C/O S.R. ONE, LIMITED 161 WASHINGTON STREET, SUITE 500 CONSHOHOCKEN PA 19428 1 0 1 0 Series B-1 Convertible Preferred Stock Common Stock 503579 I See footnotes Series B-2 Convertible Preferred Stock Common Stock 934487 I See footnotes Series B-3 Convertible Preferred Stock Common Stock 447770 I See footnotes Stock Option (Right to Buy) 12.00 2024-03-26 Common Stock 9375 D Each share of convertible preferred stock is convertible into shares of common stock at any time at the holder's election or upon the consummation of a qualified public offering of the registrant on a 1-for-35 basis. The convertible preferred stock has no expiration date. Held of record by S.R. One, Limited, an indirect, wholly-owned subsidiary of GlaxoSmithKline plc. Jill Carroll (the "Reporting Person") is a senior associate at S.R. One, Limited and an employee of GlaxoSmithKline LLC, a wholly-owned subsidiary of GlaxoSmithKline plc. The Reporting Person disclaims beneficial ownership of all the shares reported herein and this report shall not be deemed an admission of beneficial ownership of such shares for the purposes of Section 16 or for any other purpose except to the extent of her proportionate pecuniary interest therein. Option becomes exercisable in equal yearly installments over three years from the date of grant. The stock option was granted to the Reporting Person as director's compensation. As an associate of S.R. One, Limited and an employee of GlaxoSmithKline LLC, the Reporting Person is obligated to transfer any shares issued under the stock option to S.R. One, Limited. /s/ Hemmie Chang, attorney-in-fact for Jill Carroll 2014-03-26