|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 2270 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
|||
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HOMCY CHARLES J C/O GLOBAL BLOOD THERAPEUTICS, INC. 171 OYSTER POINT BLVD, SUITE 300 SOUTH SAN FRANCISCO, CA 94080 |
 X |  |  |  |
/s/ Lesley Calhoun as Attorney-in-Fact for the Reporting Person | 02/14/2018 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Includes 7,798 shares received by the Reporting Person in a distribution-in-kind by Third Rock Ventures II, L.P. ("TRV II"), which distribution was made in accordance with the exemption afforded by Rule 16a-13 of the Securities Exchange Act of 1934, as amended. |
(2) | (2) These shares were subsequently transferred to the Reporting Person's revocable trust on April 13, 2017. This report is being filed with respect to this transaction solely to correct the total number of shares directly and indirectly held by the Reporting Person immediately following the transaction. |
(3) | Includes 3,277 shares received by the Reporting Person in a distribution-in-kind by TRV II, which distribution was made in accordance with the exemption afforded by Rule 16a-13 of the Securities Exchange Act of 1934, as amended. |
(4) | These shares were subsequently transferred to the Reporting Person's revocable trust on May 25, 2017. This report is being filed with respect to this transaction solely to correct the total number of shares directly and indirectly held by the Reporting Person immediately following the transaction. |
(5) | Includes 1,504 shares received by the Reporting Person in a distribution-in-kind by TRV II, which distribution was made in accordance with the exemption afforded by Rule 16a-13 of the Securities Exchange Act of 1934, as amended. |
(6) | These shares were subsequently transferred to the Reporting Person's revocable trust on June 21, 2017. This report is being filed with respect to this transaction solely to correct the total number of shares directly and indirectly held by the Reporting Person immediately following the transaction. |
(7) | These shares were subsequently transferred to the Reporting Person's revocable trust on July 28, 2017. This report is being filed with respect to this transaction solely to correct the total number of shares directly and indirectly held by the Reporting Person immediately following the transaction. |
(8) | Includes 2,563 shares received by the Reporting Person in a distribution-in-kind by TRV II, which distribution was made in accordance with the exemption afforded by Rule 16a-13 of the Securities Exchange Act of 1934, as amended. |
(9) | These shares were subsequently transferred to the Reporting Person's revocable trust on September 26, 2017. This report is being filed with respect to this transaction solely to correct the total number of shares directly and indirectly held by the Reporting Person immediately following the transaction. |
(10) | Represents trades for 70,000 shares previously reported on Form 4 filed by the Reporting Person on October 27, 2017. These trades are being included on this Form 5 solely to correct the form of ownership immediately following the transaction. |
(11) | Includes 6,359 shares received by the Reporting Person in a distribution-in-kind by TRV II, which distribution was made in accordance with the exemption afforded by Rule 16a-13 of the Securities Exchange Act of 1934, as amended. |
(12) | These shares were subsequently transferred to the Reporting Person's revocable trust on November 28, 2017. This report is being filed with respect to this transaction solely to correct the total number of shares directly and indirectly held by the Reporting Person immediately following the transaction. |