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