SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
| |||||||||||||||
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Moderna, Inc. [ MRNA ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| ||||||||||||||||||||||||
3. Date of Earliest Transaction (Month/Day/Year) 12/11/2018 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
|
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 12/11/2018 | C | 7,292,145 | A | (5) | 7,292,145 | I | By: Flagship Ventures Fund IV, LP(1) | ||
Common Stock | 12/11/2018 | C | 1,823,036 | A | (5) | 1,823,036 | I | By: Flagship Ventures Fund IV-Rx, LP(2) | ||
Common Stock | 12/11/2018 | C | 24,782,551 | A | (6) | 32,074,696 | I | By: Flagship Ventures Fund IV, LP(1) | ||
Common Stock | 12/11/2018 | C | 6,195,632 | A | (6) | 8,018,668 | I | By: Flagship Ventures Fund IV-Rx, LP(2) | ||
Common Stock | 12/11/2018 | C | 5,713,739 | A | (7) | 37,788,435 | I | By: Flagship Ventures Fund IV, LP(1) | ||
Common Stock | 12/11/2018 | C | 1,428,432 | A | (7) | 9,447,100 | I | By: Flagship Ventures Fund IV-Rx, LP(2) | ||
Common Stock | 12/11/2018 | C | 85,989 | A | (8) | 37,874,424 | I | By: Flagship Ventures Fund IV, LP(1) | ||
Common Stock | 12/11/2018 | C | 21,496 | A | (8) | 9,468,596 | I | By: Flagship Ventures Fund IV-Rx, LP(2) | ||
Common Stock | 11,460,435 | I | By: Flagship Venture Labs IV LLC(3) | |||||||
Common Stock | 3,924 | I | By: Flagship Pioneering, Inc.(4) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
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 Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series A Preferred Stock | (5) | 12/11/2018 | C | 7,292,145 | (5) | (5) | Common Stock | 7,292,145 | (5) | 0 | I | By: Flagship Ventures Fund IV, LP(1) | |||
Series A Preferred Stock | (5) | 12/11/2018 | C | 1,823,036 | (5) | (5) | Common Stock | 1,823,036 | (5) | 0 | I | By: Flagship Ventures Fund IV-Rx, LP(2) | |||
Series B Preferred Stock | (6) | 12/11/2018 | C | 24,782,551 | (6) | (6) | Common Stock | 24,782,551 | (6) | 0 | I | By: Flagship Ventures Fund IV, LP(1) | |||
Series B Preferred Stock | (6) | 12/11/2018 | C | 6,195,632 | (6) | (6) | Common Stock | 6,195,632 | (6) | 0 | I | By: Flagship Ventures Fund IV-Rx, LP(2) | |||
Series C Preferred Stock | (7) | 12/11/2018 | C | 5,713,739 | (7) | (7) | Common Stock | 5,713,739 | (7) | 0 | I | By: Flagship Ventures Fund IV, LP(1) | |||
Series C Preferred Stock | (7) | 12/11/2018 | C | 1,428,432 | (7) | (7) | Common Stock | 1,428,432 | (7) | 0 | I | By: Flagship Ventures Fund IV-Rx, LP(2) | |||
Series D Preferred Stock | (8) | 12/11/2018 | C | 85,989 | (8) | (8) | Common Stock | 85,989 | (8) | 0 | I | By: Flagship Ventures Fund IV, LP(1) | |||
Series D Preferred Stock | (8) | 12/11/2018 | C | 21,496 | (8) | (8) | Common Stock | 21,496 | (8) | 0 | I | By: Flagship Ventures Fund IV-Rx, LP(2) |
1. Name and Address of Reporting Person*
(Street)
| ||||||||||||
1. Name and Address of Reporting Person*
(Street)
| ||||||||||||
1. Name and Address of Reporting Person*
(Street)
| ||||||||||||
1. Name and Address of Reporting Person*
(Street)
| ||||||||||||
1. Name and Address of Reporting Person*
(Street)
| ||||||||||||
1. Name and Address of Reporting Person*
(Street)
| ||||||||||||
1. Name and Address of Reporting Person*
(Street)
|
Explanation of Responses: |
1. Shares held by Flagship Ventures Fund IV, L.P. ("Flagship Fund IV"). Flagship Ventures Fund IV General Partner LLC ("Flagship Fund IV GP") is the general partner of Flagship Fund IV. Noubar B. Afeyan, Ph.D. and Edwin M. Kania, Jr. are the managers of Flagship Fund IV GP. While Mr. Kania is retired from Flagship Pioneering, Inc. ("Pioneering"), he continues to serve as a manager of Flagship Fund IV GP. Each of the reporting persons except for Flagship Fund IV disclaims beneficial ownership of such shares except to the extent of his or its pecuniary interest therein. |
2. Shares held by Flagship Ventures Fund IV-Rx, L.P. ("Flagship Fund IV-Rx"). Flagship Fund IV GP is the general partner of Flagship Fund IV-Rx. While Mr. Kania is retired from Pioneering he continues to serve as a manager of the Flagship Fund IV GP. Each of the reporting persons except for Flagship Fund IV-Rx disclaims beneficial ownership of such shares except to the extent of his or its pecuniary interest therein. |
3. Shares held by Flagship VentureLabs IV LLC ("VentureLabs IV"). Flagship Fund IV is a member of VentureLabs IV and also serves as its manager. Flagship Fund IV GP is the general partner of Flagship Fund IV. Noubar B. Afeyan, Ph.D. and Edwin M. Kania, Jr. are the managers of Flagship Fund IV GP. While Mr. Kania is retired from Pioneering he continues to serve as a manager of the Flagship Fund IV GP. Each of the reporting persons except for VentureLabs IV disclaims beneficial ownership of such shares except to the extent of his or its pecuniary interest therein. |
4. Securities held by Pioneering. Noubar B. Afeyan, Ph.D. is the CEO and a stockholder of Pioneering. Each of the reporting persons except for Pioneering disclaims beneficial ownership of such shares except to the extent of his or its pecuniary interest therein. |
5. The Series A Preferred Stock converted into shares of the Issuer's common stock, $0.0001 par value per share ("Common Stock") based on an applicable conversion ratio of 0.45576 upon the closing of the Issuer's initial public offering on December 11, 2018. The Series A Preferred Stock had no expiration date. |
6. The Series B Preferred Stock converted into Common Stock based on an applicable conversion ratio of 0.45457 upon the closing of the Issuer's initial public offering on December 11, 2018. The Series B Preferred Stock had no expiration date. |
7. The Series C Preferred Stock converted into Common Stock based on an applicable conversion ratio of 0.45853 upon the closing of the Issuer's initial public offering on December 11, 2018. The Series C Preferred Stock had no expiration date. |
8. The Series D Preferred Stock converted into Common Stock based on an applicable conversion ratio of 0.45854 upon the closing of the Issuer's initial public offering on December 11, 2018. The Series D Preferred Stock had no expiration date. |
Remarks: |
Flagship Pioneering, Inc., By: /s/ Noubar B. Afeyan, Name: Noubar B. Afeyan, Ph.D., Title: Manager | 12/13/2018 | |
Flagship Ventures Fund IV General Partner LLC, By: /s/ Noubar B. Afeyan, Name: Noubar B. Afeyan, Ph.D., Title: Manager | 12/13/2018 | |
Flagship VentureLabs IV LLC, By: Flagship Ventures Fund IV, L.P., its manager, By: Flagship Ventures Fund IV General Partner LLC, its general partner, By: /s/ Noubar B. Afeyan, Name: Noubar B. Afeyan, Ph.D., Title: Manager | 12/13/2018 | |
Flagship Ventures Fund IV, L.P., By: Flagship Ventures Fund IV General Partner LLC, its general partner, By: /s/ Noubar B. Afeyan, Name: Noubar B. Afeyan, Ph.D., Title: Manager | 12/13/2018 | |
Flagship Ventures Fund IV-Rx, L.P., By: Flagship Ventures Fund IV General Partner LLC, its general partner, By: /s/ Noubar B. Afeyan, Name: Noubar B. Afeyan, Ph.D., Title: Manager | 12/13/2018 | |
/s/ Noubar B. Afeyan, Name: Noubar B. Afeyan | 12/13/2018 | |
/s/ Edwin M. Kania Jr., Edwin M. Kania Jr. | 12/13/2018 | |
** 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 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). | ||
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. |