0001209191-20-043506.txt : 20200723
0001209191-20-043506.hdr.sgml : 20200723
20200723172231
ACCESSION NUMBER: 0001209191-20-043506
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200723
FILED AS OF DATE: 20200723
DATE AS OF CHANGE: 20200723
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BASKETT FOREST
CENTRAL INDEX KEY: 0001277631
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39402
FILM NUMBER: 201044341
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Annexon, Inc.
CENTRAL INDEX KEY: 0001528115
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 275414423
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 180 KIMBALL WAY
STREET 2: SUITE 200
CITY: SOUTH SAN FRANCISCO
STATE: CA
ZIP: 94080
BUSINESS PHONE: (650)-822-5500
MAIL ADDRESS:
STREET 1: 180 KIMBALL WAY
STREET 2: SUITE 200
CITY: SOUTH SAN FRANCISCO
STATE: CA
ZIP: 94080
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2020-07-23
0
0001528115
Annexon, Inc.
ANNX
0001277631
BASKETT FOREST
1954 GREENSPRING DRIVE
SUITE 600
TIMONIUM
MD
21093
0
0
1
0
Series B Preferred Stock
Common Stock
1591599
I
See Note 2
Series C Preferred Stock
Common Stock
672636
I
See Note 2
Series D Preferred Stock
Common Stock
231452
I
See Note 2
The shares of Series B Preferred Stock will automatically convert on a 1-for-8.81 basis into Common Stock immediately prior to the closing of the Issuer's initial public offering. The shares have no expiration date.
The Reporting Person is a manager of NEA 15 GP, LLC, which is the sole general partner of NEA Partners 15, L.P. ("NEA Partners 15"). NEA Partners 15 is the sole general partner of New Enterprise Associates 15, L.P. ("NEA 15"), which is the direct beneficial owner of the shares. The Reporting Person disclaims beneficial ownership within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise of such portion of the shares held by NEA 15 in which the Reporting Person has no pecuniary interest.
The shares of Series C Preferred Stock will automatically convert on a 1-for-8.81 basis into Common Stock immediately prior to the closing of the Issuer's initial public offering. The shares have no expiration date.
The shares of Series D Preferred Stock will automatically convert on a 1-for-8.81 basis into Common Stock immediately prior to the closing of the Issuer's initial public offering. The shares have no expiration date.
/s/ Sasha Keough, attorney-in-fact
2020-07-23