0000899243-15-001292.txt : 20150715 0000899243-15-001292.hdr.sgml : 20150715 20150715204851 ACCESSION NUMBER: 0000899243-15-001292 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20150715 FILED AS OF DATE: 20150715 DATE AS OF CHANGE: 20150715 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: CHIASMA, INC CENTRAL INDEX KEY: 0001339469 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 831 BEACON STREET STREET 2: SUITE 313 CITY: NEWTON CENTRE STATE: MA ZIP: 02459 BUSINESS PHONE: 914-234-2268 MAIL ADDRESS: STREET 1: 831 BEACON STREET STREET 2: SUITE 313 CITY: NEWTON CENTRE STATE: MA ZIP: 02459 FORMER COMPANY: FORMER CONFORMED NAME: CHIASMA INC DATE OF NAME CHANGE: 20050922 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mamluk Roni CENTRAL INDEX KEY: 0001647053 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37500 FILM NUMBER: 15990309 MAIL ADDRESS: STREET 1: CHIASMA, INC. STREET 2: 60WELLS AVENUE CITY: NEWTON STATE: MA ZIP: 02459 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2015-07-15 0 0001339469 CHIASMA, INC CHMA 0001647053 Mamluk Roni C/O CHIASMA, INC. 60 WELLS AVENUE, SUITE 102 NEWTON MA 02459 0 1 0 0 Chief Development Officer Stock Option (right to buy) 0.09 2018-10-14 Common Stock 9556 D Stock Option (right to buy) 0.09 2021-09-20 Common Stock 151139 D Stock Option (right to buy) 0.09 2022-09-12 Common Stock 82186 D Stock Option (right to buy) 3.29 2024-11-15 Common Stock 225689 D Stock Option (right to buy) 5.57 2025-04-13 Common Stock 213345 D This option is fully vested and exercisable. This option vests over a four-year period at a rate of twenty-five percent (25%) on September 7, 2012 and in 12 equal quarterly installments thereafter. This option vests over a four-year period at a rate of twenty-five percent (25%) on September 12, 2013 and in 12 equal quarterly installments thereafter. This option vests over a four-year period in 48 equal monthly installments which began on October 21, 2014. This option vests over a four-year period in 48 equal monthly installments which began on April 14, 2015. Exhibit List: Exhibit 24.1 - Power of Attorney /s/ Mark J. Fitzpatrick, Attorney-in-Fact 2015-07-15 EX-24.1 2 attachment1.htm EX-24.1 DOCUMENT



                               POWER OF ATTORNEY

        Know all by these presents, that the undersigned hereby constitutes and
appoints each of Mark Leuchtenberger and Mark Fitzpatrick, signing singly, 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 Chiasma, Inc. (the
              "Company"), Forms 3, 4 and 5 and amendments thereto in accordance
              with Section 16(a) of the Securities Exchange Act of 1934 and the
              rules thereunder;

        (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 and amendments thereto and timely
              file such form with the United States Securities and Exchange
              Commission and any stock exchange 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 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 of the Securities
Exchange Act of 1934.

        This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4 and 5 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 may be filed with the
United States Securities and Exchange Commission as a confirming statement of
the authority granted herein.

        IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed as of June 29, 2015.


                                                /s/ Roni Mamluk
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                                                        Signature

                                                    Roni Mamluk
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                                                        Print Name