0001209191-19-049967.txt : 20190917
0001209191-19-049967.hdr.sgml : 20190917
20190917204718
ACCESSION NUMBER: 0001209191-19-049967
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20190917
FILED AS OF DATE: 20190917
DATE AS OF CHANGE: 20190917
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Topsoe Jakob Haldor
CENTRAL INDEX KEY: 0001785882
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39045
FILM NUMBER: 191098234
MAIL ADDRESS:
STREET 1: 325 E MIDDLEFIELD ROAD
CITY: MOUNTAIN VIEW
STATE: CA
ZIP: 94043
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: IGM Biosciences, Inc.
CENTRAL INDEX KEY: 0001496323
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 770349194
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 325 E MIDDLEFIELD ROAD
CITY: MOUNTAIN VIEW
STATE: CA
ZIP: 94043
BUSINESS PHONE: 650-965-7873
MAIL ADDRESS:
STREET 1: 325 E MIDDLEFIELD ROAD
CITY: MOUNTAIN VIEW
STATE: CA
ZIP: 94043
FORMER COMPANY:
FORMER CONFORMED NAME: Palingen, Inc.
DATE OF NAME CHANGE: 20100712
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2019-09-17
0
0001496323
IGM Biosciences, Inc.
IGMS
0001785882
Topsoe Jakob Haldor
C/O IGM BIOSCIENCES, INC.
325 E. MIDDLEFIELD ROAD
MOUNTAIN VIEW
CA
94043
1
0
1
0
Series B Preferred Stock
0.00
Common Stock
9039453
I
See Footnote
Series C Preferred Stock
0.00
Non-Voting Common Stock
2269838
I
See Footnote
The Series B Preferred Stock will automatically convert into shares of Common Stock on a 1-for-1 basis immediately prior to the closing of the Issuer's initial public offering. The Series B Preferred Stock does not have an expiration date.
All shares are held directly by Haldor Topsoe Holding A/S (HTH). Mr. Jakob Haldor Topsoe, Ms. Christina Teng Topsoe, Mr. Martin Topsoe and Mr. Emil Oigaard, members of the board of directors of HTH, may be deemed to share voting and investment power with respect to the shares reported herein and disclaim beneficial ownership of such shares, except to the extent of his or her pecuniary interest therein, if any. Mr. Jakob Haldor Topsoe and Ms. Christina Teng Topsoe are members of the Issuer's board of directors.
The Series C Preferred Stock will automatically convert into shares of Non-Voting Common Stock on a 1-for-1 basis, pursuant to an election made by the Reporting Person, immediately prior to the closing of the Issuer's initial public offering, and has no expiration date. Each share of Non-Voting Common Stock is convertible at any time at the option of the Reporting Person into one share of Common Stock (subject to a 4.99% beneficial ownership limitation that may be increased or decreased by the Reporting Person) and has no expiration date.
/s/ Misbah Tahir, by power of attorney
2019-09-17
EX-24.3_872791
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
The undersigned, as a Section 16 reporting person of IGM Biosciences, Inc. (the
"Company"), hereby constitutes and appoints Fred Schwarzer and Misbah Tahir, and
each of them, as the undersigned's true and lawful attorney-in-fact to:
1. complete and execute Forms 3, 4 and 5 and other forms and all amendments
thereto as such attorney-in fact shall in his discretion determine to be
required or advisable pursuant to Section 16 of the Securities Exchange Act of
1934 (as amended) and the rules and regulations promulgated thereunder, or any
successor laws and regulations, as a consequence of the undersigned's ownership,
acquisition or disposition of securities of the Company; and
2. do all acts necessary in order to file such forms with the Securities and
Exchange Commission, any securities exchange or national association, the
Company and such other person or agency as the attorneys-in-fact shall deem
appropriate.
The undersigned hereby ratifies and confirms all that said attorneys-in-fact and
agents shall do or cause to be done by virtue hereof. 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 (as amended). 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 Company and the foregoing
attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 14th day of August, 2019.
JAKOB HALDOR TOPSOE
/S/ Jakob Haldor Topsoe