0001209191-19-060209.txt : 20191212 0001209191-19-060209.hdr.sgml : 20191212 20191212161511 ACCESSION NUMBER: 0001209191-19-060209 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20191205 FILED AS OF DATE: 20191212 DATE AS OF CHANGE: 20191212 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Giguere Lee CENTRAL INDEX KEY: 0001796465 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37500 FILM NUMBER: 191282008 MAIL ADDRESS: STREET 1: C/O CHIASMA, INC. STREET 2: 460 TOTTEN POND ROAD, SUITE 530 CITY: WALTHAM STATE: MA ZIP: 02451 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: 460 TOTTEN POND ROAD STREET 2: SUITE 530 CITY: WALTHAM STATE: MA ZIP: 02451 BUSINESS PHONE: 617-928-5300 MAIL ADDRESS: STREET 1: 460 TOTTEN POND ROAD STREET 2: SUITE 530 CITY: WALTHAM STATE: MA ZIP: 02451 FORMER COMPANY: FORMER CONFORMED NAME: CHIASMA INC DATE OF NAME CHANGE: 20050922 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2019-12-05 0 0001339469 CHIASMA, INC CHMA 0001796465 Giguere Lee C/O CHIASMA, INC. 460 TOTTEN POND ROAD, SUITE 530 WALTHAM MA 02451 0 1 0 0 General Counsel Stock Option (Right to Buy) 4.68 2029-10-07 Common Stock 100000 D This option shall vest over a four-year period at a rate of 25% on September 30, 2020 and in 12 equal quarterly installments thereafter. Exhibit 24.1 Power of Attorney /s/ Lee G. Giguere 2019-12-12 EX-24.3_883144 2 poa.txt POA DOCUMENT POWER OF ATTORNEY Know all by these presents, that the undersigned hereby constitutes and appoints each of Mark Fitzpatrick and Drew Enamait, 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, as amended, 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, as amended. The undersigned hereby agrees to indemnify the attorney-in-fact and the Company from and against any demand, damage, loss, cost or expense arising from any false or misleading information provided by the undersigned to the attorney-in-fact. 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. This Power of Attorney supersedes any prior power of attorney in connection with the undersigned's capacity as an officer and/or director of the Company. This Power of Attorney shall expire as to any individual attorney-in-fact if such attorney-in-fact ceases to be an executive officer of the Company. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of December 12, 2019. /s/ Lee Giguere Signature Lee Giguere Print Name