-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, GCI6ds6aEwgqbR79OHdRHyhaMt1os3xgxx/qqn5ycVuWu+0Q3GXNXqEIh5uKYek0 u+epo4nzaiuPw1fT+DLYdA== 0001104659-04-003530.txt : 20040211 0001104659-04-003530.hdr.sgml : 20040211 20040211151251 ACCESSION NUMBER: 0001104659-04-003530 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040211 FILED AS OF DATE: 20040211 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: CORGENTECH INC CENTRAL INDEX KEY: 0001131517 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 770503399 STATE OF INCORPORATION: DE BUSINESS ADDRESS: STREET 1: 601 GATEWAY BLVD STREET 2: STE 460 CITY: SOUTH SAN FRANCISCO STATE: CA ZIP: 94080 BUSINESS PHONE: 65062241690 MAIL ADDRESS: STREET 1: 650 GATEWAY BLVD CITY: SOUTH SAN FRANCISCO STATE: CA ZIP: 94080 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BRISTOL MYERS SQUIBB CO CENTRAL INDEX KEY: 0000014272 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-50573 FILM NUMBER: 04586036 BUSINESS ADDRESS: STREET 1: 345 PARK AVE CITY: NEW YORK STATE: NY ZIP: 10154 BUSINESS PHONE: 2125464000 MAIL ADDRESS: STREET 1: 345 PARK AVE CITY: NEW YORK STATE: NY ZIP: 10154 FORMER NAME: FORMER CONFORMED NAME: BRISTOL MYERS CO DATE OF NAME CHANGE: 19891012 3 1 a3.xml 3 X0201 3 2004-02-11 0 0001131517 CORGENTECH INC CGTK 0000014272 BRISTOL MYERS SQUIBB CO 345 PARK AVENUE NEW YORK NY 10154 0 0 1 0 Series D Preferred Stock 2004-02-11 Common Stock 2079002 D The Issuer's preferred stock will automatically convert into Common Stock on a one-for-one basis upon the closing of the Issuer's initial public offering. /s/ Sandra Leung, Vice President and Secretary 2004-02-11 -----END PRIVACY-ENHANCED MESSAGE-----