0001104659-18-047445.txt : 20180726
0001104659-18-047445.hdr.sgml : 20180726
20180726171603
ACCESSION NUMBER: 0001104659-18-047445
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180724
FILED AS OF DATE: 20180726
DATE AS OF CHANGE: 20180726
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Forbion Capital Fund III Cooperatief U.A.
CENTRAL INDEX KEY: 0001747586
STATE OF INCORPORATION: P7
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38596
FILM NUMBER: 18972523
BUSINESS ADDRESS:
STREET 1: C/O FORBION CAPITAL PARTNERS
STREET 2: GOOIMEER 2-35
CITY: NAARDEN
STATE: P7
ZIP: 1411DC
BUSINESS PHONE: 31 35 6993000
MAIL ADDRESS:
STREET 1: C/O FORBION CAPITAL PARTNERS
STREET 2: GOOIMEER 2-35
CITY: NAARDEN
STATE: P7
ZIP: 1411DC
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Replimune Group, Inc.
CENTRAL INDEX KEY: 0001737953
STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836]
IRS NUMBER: 822082553
STATE OF INCORPORATION: MA
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 18 COMMERCE WAY
CITY: WOBURN
STATE: MA
ZIP: 01801
BUSINESS PHONE: 781-995-2443
MAIL ADDRESS:
STREET 1: 18 COMMERCE WAY
CITY: WOBURN
STATE: MA
ZIP: 01801
4
1
a4.xml
4
X0306
4
2018-07-24
0
0001737953
Replimune Group, Inc.
REPL
0001747586
Forbion Capital Fund III Cooperatief U.A.
C/O FORBION CAPITAL PARTNERS,
GOOIMEER 2-35
NAARDEN
P7
1411 DC
NETHERLANDS
0
0
1
0
Common Stock
2018-07-24
4
C
0
994688
A
994688
I
See footnote
Common Stock
2018-07-24
4
C
0
2579881
A
3574569
I
See footnote
Common Stock
2018-07-24
4
C
0
1013547
A
4588116
I
See footnote
Common Stock
2018-07-24
4
P
0
133333
15.00
A
4721449
I
See footnote
Warrant (right to buy)
2018-07-24
4
C
0
248672
0
A
Common Stock
248672
248672
I
See footnote
Warrant (right to buy)
2018-07-24
4
C
0
248672
0
D
Series Seed Convertible Preferred Stock
248672
0
I
See footnote
Series Seed Convertible Preferred Stock
2018-07-24
4
C
0
994688
0
D
Common Stock
994688
0
I
See footnote
Series A Convertible Preferred Stock
2018-07-24
4
C
0
2579881
0
D
Common Stock
2579881
0
I
See footnote
Series B Convertible Preferred Stock
2018-07-24
4
C
0
1013547
0
D
Common Stock
1013547
0
I
See footnote
In connection with the completion of the Issuer's initial public offering, each share of the Issuer's series seed convertible preferred stock, series A convertible preferred stock and series B convertible preferred stock (collectively, the "Preferred Stock") converted into shares of the Issuer's common stock on a 1-for-9.94688 basis without payment or consideration. The Preferred Stock had no expiration date.
The securities are held directly by Forbion Capital Fund III Cooperatief U.A. ("Forbion Coop"). Forbion III Management B.V. ("Forbion Management") is the director of Forbion Coop and may be deemed to have voting, investment and dispositive power with respect to the shares held by Forbion Coop. Forbion Management disclaims Section 16 beneficial ownership of the shares held by Forbion Coop, except to the extent, if any, of its pecuniary interest therein.
Reflects warrants to acquire shares of the Issuer's Series Seed Convertible Preferred Stock which automatically converted into warrants to acquire shares of the Issuer's common stock immediately prior to the completion of the Issuer's initial public offering on a 1-for-9.94688 basis without payment or consideration. The warrants have no expiration date. The exercise price is $1.01 per share of the Issuer's common stock.
Reflects the number of shares of applicable series of preferred stock held by the Reporting Person on an as-converted to common stock basis.
Forbion III Management B.V., director of Forbion Capital Fund III Cooperatief U.A /s/ By M.A. van Osch and H.A. Slootweg, as directors
2018-07-26