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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT 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 |
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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 1474 (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 Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series A Preferred Stock | (1) | 09/22/2015 | C | 722,485 | (1) | (1) | Common Stock | 722,485 | $ 0 | 0 | I | See Footnote (2) | |||
Series A Preferred Stock | (1) | 09/22/2015 | C | 722,485 | (1) | (1) | Common Stock | 722,485 | $ 0 | 0 | I | See Footnote (3) | |||
Series B Preferred Stock | (1) | 09/22/2015 | C | 853,915 | (1) | (1) | Common Stock | 853,915 | $ 0 | 0 | I | See Footnote (3) | |||
Series C Preferred Stock | (1) | 09/22/2015 | C | 478,463 | (1) | (1) | Common Stock | 478,463 | $ 0 | 0 | I | See Footnote (3) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Fox Allan M. C/O REGENXBIO INC. 9712 MEDICAL CENTER DRIVE, SUITE 100 ROCKVILLE, MD 20850 |
X | X |
/s/ Allan M. Fox | 09/22/2015 | |
**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) | Each share of Preferred Series A, Preferred Series B, and Preferred Series C Stock is convertible and will automatically convert on a 1:1 basis into the Issuer's common stock upon the closing of the Issuer's initial public offering of common stock pursuant to an effective registration statement filed with the U.S. Securities and Exchange Commission. These shares have no expiration date. |
(2) | The Reporting Person is a trustee of The Allan M. Fox Trust (U/A/D April 21, 2015), the direct beneficial owner of the shares. The Reporting Person disclaims beneficial ownership within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise or such portion of the shares of common stock of the Issuer held by The Allan M. Fox Trust (U/A/D April 21, 2015), in which the Reporting Person has no pecuniary interest. |
(3) | The Reporting Person is a trustee of The Allan M. Fox Revocable Trust, the direct beneficial owner of the shares. The Reporting Person disclaims beneficial ownership within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise or such portion of the shares of common stock of the Issuer held by The Allan M. Fox Revocable Trust, in which the Reporting Person has no pecuniary interest. |
(4) | The Reporting Person holds shared dispositive power over the shares held by FoxKiser Holdings, LLC with John Daniel Kiser, with the Reporting Person having a 60% voting interest in FoxKiser Holdings, LLC. |