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