0001209191-22-002775.txt : 20220110
0001209191-22-002775.hdr.sgml : 20220110
20220110212811
ACCESSION NUMBER: 0001209191-22-002775
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20220101
FILED AS OF DATE: 20220110
DATE AS OF CHANGE: 20220110
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Liao Carrie
CENTRAL INDEX KEY: 0001899817
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40360
FILM NUMBER: 22522590
MAIL ADDRESS:
STREET 1: C/O MIND MEDICINE INC.
STREET 2: ONE WORLD TRADE CENTER, SUITE 8500
CITY: NEW YORK
STATE: NY
ZIP: 10007
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Mind Medicine (MindMed) Inc.
CENTRAL INDEX KEY: 0001813814
STANDARD INDUSTRIAL CLASSIFICATION: MEDICINAL CHEMICALS & BOTANICAL PRODUCTS [2833]
IRS NUMBER: 000000000
STATE OF INCORPORATION: A1
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1166 ALBERNI STEET
STREET 2: SUITE 1604
CITY: VANCOUVER
STATE: A1
ZIP: V6E 3Z3
BUSINESS PHONE: (212) 220-6633
MAIL ADDRESS:
STREET 1: 1166 ALBERNI STEET
STREET 2: SUITE 1604
CITY: VANCOUVER
STATE: A1
ZIP: V6E 3Z3
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2022-01-01
1
0001813814
Mind Medicine (MindMed) Inc.
MNMD
0001899817
Liao Carrie
C/O MIND MEDICINE (MINDMED), INC.
ONE WORLD TRADE CENTER, SUITE 8500
NEW YORK
NY
10007
0
1
0
0
VP, Controller&Acct Principal
No Table I or Table II securities beneficially owned
Exhibit List - Exhibit 24 - Power of Attorney
/s/ Robert Barrow, Attorney-in-Fact
2022-01-10
EX-24
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
(For Executing Form ID and Forms 3, 4 and 5)
Know all by these presents, that the undersigned hereby constitutes and
appoints each of Yoon-jee Kim, Natasha S. Patel, Andrew J. Durand and Jill Simon
of Cooley LLP, and Robert Barrow, Cynthia Hu and Nico Forte of Mind Medicine
(MindMed), Inc. (the "Company"), signing individually, the undersigned's true
and lawful attorneys-in fact and agents to:
(1) Prepare, execute in the undersigned's name and on the undersigned's behalf,
and submit to the Securities and Exchange Commission (the "SEC") Form ID and
Forms 3, 4 and 5 (including amendments thereto and joint filing agreements in
connection therewith) in accordance with Section 16(a) of the Securities
Exchange Act of 1934, as amended (the "Exchange Act") and the rules thereunder
in the undersigned's capacity as an officer, director or beneficial owner of
more than 10% of a registered class of securities of the Company;
(2) Do and perform any and all acts for and on behalf of the undersigned that
may be necessary or desirable to prepare and execute any such Forms 3, 4 or 5
(including amendments thereto and joint filing agreements in connection
therewith) and file such forms with the SEC and any stock exchange,
self-regulatory association or any similar authority; and
(3) Take any other action of any type whatsoever in connection with the
foregoing that, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required of the undersigned, it being
understood that the documents executed by the attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as the attorney-in-fact may approve in the
attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney in fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney in fact, or such attorney
in fact's substitute or substitutes, shall lawfully do or cause to be done by
virtue of this power of attorney and the rights and powers herein granted. The
undersigned acknowledges that the foregoing attorneys-in-fact, and their
substitutes, 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 Exchange Act.
This Power of Attorney shall remain in full force and effect until the earliest
to occur of (a) 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, (b) revocation by the undersigned in a signed writing
delivered to the Company and the foregoing attorneys-in fact or (c) as to any
attorney-in-fact individually, until such attorney-in-fact is no longer employed
by the Company or Cooley LLP, as applicable.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of the date written below.
Date: December 13, 2021
By: /s/ Carrie Liao
Name: Carrie Liao