0001209191-14-077076.txt : 20141219
0001209191-14-077076.hdr.sgml : 20141219
20141219172151
ACCESSION NUMBER: 0001209191-14-077076
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20141217
FILED AS OF DATE: 20141219
DATE AS OF CHANGE: 20141219
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: BELLICUM PHARMACEUTICALS, INC
CENTRAL INDEX KEY: 0001358403
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
BUSINESS ADDRESS:
STREET 1: 2130 WEST HOLCOMBE BOULEVARD
STREET 2: SUITE 850
CITY: HOUSTON
STATE: TX
ZIP: 77030
BUSINESS PHONE: (832) 384-1100
MAIL ADDRESS:
STREET 1: 2130 WEST HOLCOMBE BOULEVARD
STREET 2: SUITE 850
CITY: HOUSTON
STATE: TX
ZIP: 77030
FORMER COMPANY:
FORMER CONFORMED NAME: BELLICUM PHARMACEUTICALS INC
DATE OF NAME CHANGE: 20060405
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Slawin Kevin M.
CENTRAL INDEX KEY: 0001626808
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36783
FILM NUMBER: 141300638
MAIL ADDRESS:
STREET 1: C/O BELLICUM PHARMACEUTICALS, INC.
STREET 2: 2130 W. HOLCOMBE BLVD., STE. 800
CITY: HOUSTON
STATE: TX
ZIP: 77030
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2014-12-17
0
0001358403
BELLICUM PHARMACEUTICALS, INC
BLCM
0001626808
Slawin Kevin M.
C/O BELLICUM PHARMACEUTICALS, INC.
2130 W. HOLCOMBE BLVD., STE. 800
HOUSTON
TX
77030
1
1
0
0
CMO and CTO
Warrant to Purchase Series C Preferred Stock (right to buy)
6.00
2014-12-17
4
X
0
25277
0.00
D
2014-08-22
2019-08-22
Series C Preferred Stock
25277
0
D
Series C Convertible Preferred Stock
2014-12-17
4
X
0
25277
A
Common Stock
14868
14868
D
Warrant to Purchase Series C Preferred Stock (right to buy)
6.00
2014-12-17
4
X
0
71063
0.00
D
2014-08-22
2019-08-22
Series C Preferred Stock
71063
0
I
By the Jordana Slawin 2012 Family Trust
Series C Convertible Preferred Stock
2014-12-17
4
X
0
71063
A
Common Stock
41801
41801
I
By the Jordana Slawin 2012 Family Trust
Warrant to Purchase Series C Preferred Stock (right to buy)
6.00
2014-12-17
4
X
0
61933
0.00
D
2014-08-22
2019-08-22
Series C Preferred Stock
61933
0
I
By the Kevin Slawin 2009 Family Trust
Series C Convertible Preferred Stock
2014-12-17
4
X
0
61933
A
Common Stock
36431
36431
I
By the Kevin Slawin 2009 Family Trust
Warrant to Purchase Series C Preferred Stock (right to buy)
6.00
2014-12-17
4
X
0
17311
0.00
D
2014-08-22
2019-08-22
Series C Preferred Stock
17311
0
I
By the 2009 Slawin Family Partnership
Series C Convertible Preferred Stock
2014-12-17
4
X
0
17311
A
Common Stock
10182
10182
I
By the 2009 Slawin Family Partnership
Upon the date immediately following the date of the effectiveness of the initial public offering of the Issuer, on or prior to March 31, 2015, this Warrant will be terminated if not previously exercised.
The Preferred Stock is convertible at any time.
The Series C Convertible Preferred Stock (the "Preferred Stock") are convertible into the Issuer's common stock at a conversion rate of 1 share of common stock for each 1.7 shares of Preferred Stock and have no expiration date.
The Reporting Person's spouse is trustee of the Jordana Slawin 2012 Family Trust. The Reporting Person disclaims beneficial ownership of these securities, and the filing of this report is not an admission that the Reporting Person is the beneficial owner of these securities for purposes of Section 16 or for any other purpose.
The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose.
The Reporting Person is a managing partner of the 2009 Slawin Family Partnership that owns the reported securities. The Reporting Person has the dispositive power and control over the securities held by such partnership. The Reporting Person disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein.
/s/ Kevin M. Slawin, M.D.
2014-12-19