0001140361-15-016255.txt : 20150423
0001140361-15-016255.hdr.sgml : 20150423
20150423165726
ACCESSION NUMBER: 0001140361-15-016255
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150421
FILED AS OF DATE: 20150423
DATE AS OF CHANGE: 20150423
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Avalanche Biotechnologies, Inc.
CENTRAL INDEX KEY: 0001501756
STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836]
IRS NUMBER: 205258327
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1035 O?BRIEN DRIVE, SUITE A
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-272-6269
MAIL ADDRESS:
STREET 1: 1035 O?BRIEN DRIVE, SUITE A
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Chalberg Thomas W.
CENTRAL INDEX KEY: 0001614872
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36579
FILM NUMBER: 15789096
MAIL ADDRESS:
STREET 1: C/O AVALANCHE BIOTECHNOLOGIES, INC.
STREET 2: 1035 O'BRIEN DRIVE, SUITE A
CITY: MENLO PARK
STATE: CA
ZIP: 94025
4
1
doc1.xml
FORM 4
X0306
4
2015-04-21
0
0001501756
Avalanche Biotechnologies, Inc.
AAVL
0001614872
Chalberg Thomas W.
C/O AVALANCHE BIOTECHNOLOGIES, INC.
1035 O'BRIEN DRIVE, SUITE A
MENLO PARK
CA
94025
1
1
0
0
Chief Executive Officer
Common Stock
2015-04-21
4
A
0
23000
0.00
A
308988
D
Common Stock
420000
I
See Footnote
Common Stock
420000
I
See Footnote
Common Stock
413
I
See Footnote
Stock Option (Right to Buy)
39.35
2015-04-21
4
A
0
67000
0.00
A
2025-04-20
Common Stock
67000
67000
D
Restricted Stock Units ("RSUs"). The Reporting Person is entitled to receive one (1) share of Common Stock of the Issuer for each one (1) RSU upon the vesting thereof. Such RSUs vest with respect to 25% of the shares subject thereto on each of the first, second, third and fourth anniversary of April 21, 2015.
The shares are held directly by Thomas W. Chalberg, as Trustee of the Thomas W. Chalberg 2014 Grantor Retained Annuity Trust under agreement dated April 30, 2014.
The shares are held directly by the Stefanie R. Chalberg 2014 Grantor Retained Annuity Trust under agreement Dated April 30, 2014.
The shares are held directly by the 2009 Chalberg Family Trust, Thomas W. Chalberg, Jr. and Stefanie Raue Chalberg, Trustees.
Twenty-five percent (25%) of the shares subject to the option vest and become exercisable on the first anniversary measured from April 21, 2015, and the remaining shares subject to the option vest and become exercisable in 36 successive, equal monthly installments thereafter, subject to the Reporting Person's continued employment or service relationship with the Issuer on each such vesting date.
/s/ Michael Swartzburg, Attorney-in-Fact for Thomas W. Chalberg
2015-04-23