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