0001209191-21-020023.txt : 20210311 0001209191-21-020023.hdr.sgml : 20210311 20210311213429 ACCESSION NUMBER: 0001209191-21-020023 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20210311 FILED AS OF DATE: 20210311 DATE AS OF CHANGE: 20210311 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Yamada Tadataka CENTRAL INDEX KEY: 0001402530 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40187 FILM NUMBER: 21735198 MAIL ADDRESS: STREET 1: COVIDIEN LTD. STREET 2: 15 HAMPSHIRE STREET CITY: MANSFIELD STATE: MA ZIP: 02048 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Prometheus Biosciences, Inc. CENTRAL INDEX KEY: 0001718852 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 814282653 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 9410 CARROLL PARK DRIVE CITY: SAN DIEGO STATE: CA ZIP: 92121 BUSINESS PHONE: (858) 200-7888 MAIL ADDRESS: STREET 1: 9410 CARROLL PARK DRIVE CITY: SAN DIEGO STATE: CA ZIP: 92121 FORMER COMPANY: FORMER CONFORMED NAME: Precision IBD, Inc. DATE OF NAME CHANGE: 20171004 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2021-03-11 0 0001718852 Prometheus Biosciences, Inc. RXDX 0001402530 Yamada Tadataka C/O PROMETHEUS BIOSCIENCES, INC. 9410 CARROLL PARK DRIVE SAN DIEGO CA 92121 1 0 0 1 and Chairman of the Board Series B Preferred Stock Common Stock 13333 D Stock Option (Right to Buy) 0.50 2027-09-11 Common Stock 25000 D Stock Option (Right to Buy) 0.50 2027-11-29 Common Stock 15000 D Stock Option (Right to Buy) 0.50 2028-05-22 Common Stock 100000 D Stock Option (Right to Buy) 3.70 2030-12-17 Common Stock 114040 D Stock Option (Right to Buy) 6.70 2031-02-03 Common Stock 135913 D Shares of Series B Preferred Stock are convertible at any time, at the holder's election, at a ratio of ten-for-one share of the Issuer's common stock. In addition, effective immediately prior to the closing of the Issuer's initial public offering of its common stock, each share of Series B Preferred Stock will automatically convert at the ratio of ten-for-one share of the Issuer's common stock. The Series B Preferred Stock has no expiration date. 25% of the shares subject to the option will vest on September 12, 2018, and 1/48th of the shares subject to the option will vest monthly thereafter, subject to the Report Person's continued service with the Issuer through each vest date. 25% of the shares subject to the option will vest on November 30, 2018, and 1/48th of the shares subject to the option will vest monthly thereafter, subject to the Report Person's continued service with the Issuer through each vest date. 25% of the shares subject to the option will vest on May 23, 2019, and 1/48th of the shares subject to the option will vest monthly thereafter, subject to the Report Person's continued service with the Issuer through each vest date. 25% of the shares subject to the option will vest on November 5, 2021, and 1/48th of the shares subject to the option will vest monthly thereafter, subject to the Report Person's continued service with the Issuer through each vest date. 25% of the shares subject to the option will vest on February 4, 2022, and 1/48th of the shares subject to the option will vest monthly thereafter, subject to the Report Person's continued service with the Issuer through each vest date. /s/Timothy K. Andrews, attorney-in-fact for Tadataka Yamada 2021-03-11 EX-24.3_972501 2 poa.txt POA DOCUMENT POWER OF ATTORNEY Know all by these presents, that the undersigned hereby constitutes and appoints each of the Chief Financial Officer, who is currently Keith W. Marshall, Ph.D and the General Counsel, who is currently Timothy K. Andrews, and their respective successors, signing singly, the undersigned's true and lawful attorney-in-fact to: (1) prepare, execute in the undersigned's name and on the undersigned's behalf, and submit to the U.S. Securities and Exchange Commission (the "SEC") a Form ID, including amendments thereto, and any other documents necessary or appropriate to obtain codes and passwords enabling the undersigned to make electronic filings with the SEC of reports required by Section 16(a) of the Securities Exchange Act of 1934 or any rule or regulation of the SEC; (2) execute for and on behalf of the undersigned, in the undersigned's capacity as an officer and/or director of Prometheus Biosciences, Inc., a Delaware corporation (the "Company") and/or beneficial owner of more than 10% of the Company's capital stock, Forms 3, 4, and 5 and any amendments thereto in accordance with Section 16(a) of the Securities Exchange Act of 1934 and the rules thereunder; (3) 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, complete and execute any amendment or amendments thereto, and timely file such form with the SEC and any stock exchange or similar authority; and (4) 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. The undersigned agrees that each such attorney-in-fact herein may rely entirely on information furnished orally or in writing by the undersigned to such attorney-in-fact. The undersigned also agrees to indemnify and hold harmless the Company and each such attorney-in-fact against an losses, claims, damages or liabilities (or actions in these reports) that arise out of or are based upon any untrue statements or omission of necessary facts in the information provided by the undersigned to such attorney-in-fact for purposes of executing, acknowledging, delivering or filing Forms 3, 4 or 5 (including amendments thereto) or Form ID and agrees to reimburse the Company and such attorney-in-fact for any legal or other expenses reasonably incurred in connection with investigating or defending against any such loss, claim, damage, liability or action. This Power of Attorney supersedes any power of attorney previously executed by the undersigned regarding the purposes outlined in the first paragraph hereof ("Prior Powers of Attorney"), and the authority of the attorney-in-fact named in any Prior Powers of Attorney is hereby revoked. 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. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 25th day of February, 2021. Signature: /s/Tadataka Yamada Name: Tadataka Yamada, M.D.