0001209191-14-077762.txt : 20141223 0001209191-14-077762.hdr.sgml : 20141223 20141223163335 ACCESSION NUMBER: 0001209191-14-077762 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20141223 FILED AS OF DATE: 20141223 DATE AS OF CHANGE: 20141223 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: 141307309 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 2014-12-23 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 Common Stock 2014-12-23 4 C 0 17135 A 356370 I By the Jordana Slawin 2012 Family Trust Common Stock 2014-12-23 4 C 0 64310 A 420680 I By the Jordana Slawin 2012 Family Trust Common Stock 2014-12-23 4 C 0 41801 A 462481 I By the Jordana Slawin 2012 Family Trust Common Stock 2014-12-23 4 C 0 16470 A 310587 I By the Kevin Slawin 2009 Family Trust Common Stock 2014-12-23 4 C 0 56048 A 366635 I By the Kevin Slawin 2009 Family Trust Common Stock 2014-12-23 4 C 0 36431 A 403066 I By the Kevin Slawin 2009 Family Trust Common Stock 2014-12-23 4 C 0 16904 A 21805 I By the 2009 Slawin Family Partnership Common Stock 2014-12-23 4 C 0 65008 A 86813 I By the 2009 Slawin Family Partnership Common Stock 2014-12-23 4 C 0 15666 A 102479 I By the 2009 Slawin Family Partnership Common Stock 2014-12-23 4 C 0 10182 A 112661 I By the 2009 Slawin Family Partnership Common Stock 2014-12-23 4 J 0 2537 A 115198 I By the 2009 Slawin Family Partnership Common Stock 2014-12-23 4 C 0 22875 A 149639 D Common Stock 2014-12-23 4 C 0 14868 A 164507 D Series A Convertible Preferred Stock 2014-12-23 4 C 0 29130 0.00 D Common Stock 17135 0 I By the Jordana Slawin 2012 Family Trust Series A Convertible Preferred Stock 2014-12-23 4 C 0 28000 0.00 D Common Stock 16470 0 I By the Kevin Slawin 2009 Family Trust Series A Convertible Preferred Stock 2014-12-23 4 C 0 28737 0.00 D Common Stock 16904 0 I By the 2009 Slawin Family Partnership Series B Convertible Participating Preferred Stock 2014-12-23 4 C 0 110514 0.00 D Common Stock 65008 0 I By the 2009 Slawin Family Partnership Series C Convertible Preferred Stock 2014-12-23 4 C 0 38889 0.00 D Common Stock 22875 0 D Series C Convertible Preferred Stock 2014-12-23 4 C 0 109328 0.00 D Common Stock 64310 0 I By the Jordana Slawin 2012 Family Trust Series C Convertible Preferred Stock 2014-12-23 4 C 0 95283 0.00 D Common Stock 56048 0 I By the Kevin Slawin 2009 Family Trust Series C Convertible Preferred Stock 2014-12-23 4 C 0 26633 0.00 D Common Stock 15666 0 I By the 2009 Slawin Family Partnership Series C Convertible Preferred Stock 2014-12-23 4 C 0 25277 0.00 D Common Stock 14868 0 D Series C Convertible Preferred Stock 2014-12-23 4 C 0 71063 0.00 D Common Stock 41801 0 I By the Jordana Slawin 2012 Family Trust Series C Convertible Preferred Stock 2014-12-23 4 C 0 61933 0.00 D Common Stock 36431 0 I By the Kevin Slawin 2009 Family Trust Series C Convertible Preferred Stock 2014-12-23 4 C 0 17311 0.00 D Common Stock 10182 0 I By the 2009 Slawin Family Partnership The Series A Convertible Preferred Stock converted into the Issuer's common stock on a 1.7-for-1 basis and had 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 Series C Convertible Preferred Stock converted into the Issuer's common stock on a 1.7-for-1 basis and had no expiration date. 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. The Series B Convertible Preferred Stock converted into the Issuer's common stock on a 1.7-for-1 basis and had no expiration date. On December 4, 2014, the Board of Directors of the Issuer declared a dividend payable to all holders of records of the Series B Convertible Participating Preferred Stock of the Issuer on December 16, 2014, payable in the form of cash or in shares of Common Stock of the Issuer, at the option of each holder. The dividends occurred in connection with the closing of the Issuer's public offering. The Reporting Person elected to receive the shares of Common Stock. Reflects 1.7-for-1 reverse stock split which became effective on December 5, 2014. /s/ Kevin M. Slawin, M.D. 2014-12-23