SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 05/11/2016 | 3. Issuer Name and Ticker or Trading Symbol Adverum Biotechnologies, Inc. [ ADVM ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 6,660,981 | I | Through Versant Capital IV (Switzerland) GmbH(1) |
Common Stock | 2,176 | I | Through Versant Side Fund IV, L.P.(2) |
Common Stock | 340,735 | I | Through Versant Venture Capital IV, L.P.(3) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. The shares are owned directly by Versant Capital IV (Switzerland) GmbH ("Versant Switzerland"). Versant Switzerland is wholly owned by Versant IV Luxco S.a r.l. ("Versant Luxembourg") and Versant Luxembourg is majority owned by Versant Venture Capital IV, L.P. and minority owned by Versant Side Fund IV, L.P. (Versant Venture Capital IV, L.P. and Versant Side Fund IV, L.P., collectively, the "Versant Funds"). Versant Ventures IV, LLC ("Ventures IV") is the general partner of each of the Versant Funds. Each of Versant Switzerland, Versant Luxembourg, Versant Venture Capital IV, L.P. and Ventures IV may be deemed a beneficial owner of these shares, but each disclaims such beneficial ownership except to the extent of its pecuniary interest therein. |
2. The shares are owned directly by Versant Side Fund IV, L.P. Each of Versant Side Fund IV, L.P. and Ventures IV may be deemed a beneficial owner of these shares, but each disclaims such beneficial ownership except to the extent of its pecuniary interest therein. |
3. The shares are owned directly by Versant Venture Capital IV, L.P. Each of Versant Venture Capital IV, L.P. and Ventures IV may be deemed a beneficial owner of these shares, but each disclaims such beneficial ownership except to the extent of its pecuniary interest therein. |
Versant Ventures IV, LLC By: Robin L. Praeger Its: Managing Director /s/ Robin L. Praeger | 05/18/2016 | |
Versant Venture Capital IV, L.P. By: Versant Ventures IV, LLC Its: General Partner By: Robin L. Praeger Its: Managing Director /s/ Robin L. Praeger | 05/18/2016 | |
Versant IV Luxco S.a r.l. By: Robin L. Praeger Its: Director /s/ Robin L. Praeger | 05/18/2016 | |
Versant Capital IV (Switzerland) GmbH By: Robin L. Praeger Its: Director /s/ Robin L. Praeger | 05/18/2016 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |