SEC FORM
3
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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OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
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8755 WEST HIGGINS ROAD, SUITE 1025 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 10/19/2022
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3. Issuer Name and Ticker or Trading Symbol
Prime Medicine, Inc.
[ PRME ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Form filed by One Reporting Person |
X |
Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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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)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Series A Convertible Preferred Stock |
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Common Stock |
5,361,122 |
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I |
By ARCH Venture Fund X, L.P
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Series A Convertible Preferred Stock |
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Common Stock |
5,361,122 |
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I |
By ARCH Venture Fund X Overage, L.P.
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Series B Convertible Preferred Stock |
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Common Stock |
367,175 |
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I |
By ARCH Venture Fund X, L.P.
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Series B Convertible Preferred Stock |
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Common Stock |
367,175 |
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I |
By ARCH Venture Fund X Overage, L.P.
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1. Name and Address of Reporting Person*
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8755 WEST HIGGINS ROAD, SUITE 1025 |
(Street)
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1. Name and Address of Reporting Person*
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8755 WEST HIGGINS ROAD, SUITE 1025 |
(Street)
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1. Name and Address of Reporting Person*
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8755 WEST HIGGINS ROAD, SUITE 1025 |
(Street)
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1. Name and Address of Reporting Person*
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8755 WEST HIGGINS ROAD, SUITE 1025 |
(Street)
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1. Name and Address of Reporting Person*
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8755 WEST HIGGINS ROAD, SUITE 1025 |
(Street)
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1. Name and Address of Reporting Person*
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8755 WEST HIGGINS ROAD, SUITE 1025 |
(Street)
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1. Name and Address of Reporting Person*
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8755 WEST HIGGINS ROAD, SUITE 1025 |
(Street)
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1. Name and Address of Reporting Person*
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8755 WEST HIGGINS ROAD, SUITE 1025 |
(Street)
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Explanation of Responses: |
Remarks: |
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/s/ ARCH Venture Fund X, L.P., By: ARCH Venture Partners X, L.P., its General Partner, By: ARCH Venture Partners X, LLC, its General Partner, By: Mark McDonnell, attorney-in-fact |
10/19/2022 |
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/s/ ARCH Venture Fund X Overage, L.P., By: ARCH Venture Partners X Overage, L.P., its General Partner, By: ARCH Venture Partners X, LLC, its General Partner, By: Mark McDonnell, attorney-in-fact |
10/19/2022 |
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/s/ ARCH Venture Partners X, L.P., By: ARCH Venture Partners X, LLC, its General Partner, By: Mark McDonnell, attorney-in-fact |
10/19/2022 |
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/s/ ARCH Venture Partners X Overage, L.P., By: ARCH Venture Partners X, LLC, its General Partner, By: Mark McDonnell, attorney-in-fact |
10/19/2022 |
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/s/ ARCH Venture Partners X, LLC, By: Mark McDonnell, attorney-in-fact |
10/19/2022 |
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/s/ Keith Crandell, By: Mark McDonnell, attorney-in-fact |
10/19/2022 |
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/s/ Kristina Burow, By: Mark McDonnell, attorney-in-fact |
10/19/2022 |
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/s/ Steven Gillis, By: Mark McDonnell, attorney-in-fact |
10/19/2022 |
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** 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. |
POWERS OF ATTORNEY
Exhibit 24
KNOW ALL MEN BY THESE PRESENTS, that each person whose signature appears below hereby constitutes and appoints Mark McDonnell his true and lawful attorney-in-fact, with full power of substitution, to sign any and all instruments, certificates and documents that may be necessary, desirable or appropriate to be executed on behalf of himself as an individual or in his capacity as a direct or indirect general partner, director, officer or manager of any partnership, corporation or limited liability company, pursuant to section 13 or 16 of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), and any and all regulations promulgated thereunder, and to file the same, with all exhibits thereto, and any other documents in connection therewith, with the Securities and Exchange Commission, and with any other entity when and if such is mandated by the Exchange Act or by the Financial Industry Regulatory Authority, granting unto said attorney-in-fact full power and authority to do and perform each and every act and thing necessary, desirable or appropriate, fully to all intents and purposes as he might or could do in person, thereby ratifying and confirming all that said attorney-in-fact, or his substitutes, may lawfully do or cause to be done by virtue hereof.
IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 29th day of January, 2021.
ARCH VENTURE FUND X, L.P.
By: ARCH Venture Partners X, L.P.
its General Partner
By: ARCH Venture Partners X, LLC.
its General Partner
By: /s/ Keith Crandell
__________________________
Managing Director
ARCH VENTURE PARTNERS X, L.P.
By: ARCH Venture Partners X, LLC
its General Partner
By: /s/ Keith Crandell
__________________________
Managing Director
ARCH VENTURE PARTNERS X, LLC
By: /s/ Keith Crandell
__________________________
Managing Director
/s/ Keith Crandell
___________________
Keith Crandell
/s/Robert Nelsen
___________________
Robert Nelsen
/s/Kristina Burow
___________________
Kristina Burow
/s/Steven Gillis
___________________
Steven Gillis
POWERS OF ATTORNEY
Exhibit 24.1
KNOW ALL MEN BY THESE PRESENTS, that each person whose signature appears below hereby constitutes and appoints Mark McDonnell his true and lawful attorney-in-fact, with full power of substitution, to sign any and all instruments, certificates and documents that may be necessary, desirable or appropriate to be executed on behalf of himself as an individual or in his capacity as a direct or indirect general partner, director, officer or manager of any partnership, corporation or limited liability company, pursuant to section 13 or 16 of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), and any and all regulations promulgated thereunder, and to file the same, with all exhibits thereto, and any other documents in connection therewith, with the Securities and Exchange Commission, and with any other entity when and if such is mandated by the Exchange Act or by the Financial Industry Regulatory Authority, granting unto said attorney-in-fact full power and authority to do and perform each and every act and thing necessary, desirable or appropriate, fully to all intents and purposes as he might or could do in person, thereby ratifying and confirming all that said attorney-in-fact, or his substitutes, may lawfully do or cause to be done by virtue hereof.
IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 29th day of January, 2021.
ARCH VENTURE FUND X OVERAGE, L.P.
By: ARCH Venture Partners X Overage, L.P.
its General Partner
By: ARCH Venture Partners X, LLC.
its General Partner
By: /s/ Keith Crandell
__________________________
Managing Director
ARCH VENTURE PARTNERS X OVERAGE, L.P.
By: ARCH Venture Partners X, LLC
its General Partner
By: /s/ Keith Crandell
__________________________
Managing Director
ARCH VENTURE PARTNERS X, LLC
By: /s/ Keith Crandell
__________________________
Managing Director
/s/ Keith Crandell
___________________
Keith Crandell
/s/Robert Nelsen
___________________
Robert Nelsen
/s/Kristina Burow
___________________
Kristina Burow
/s/Steven Gillis
___________________
Steven Gillis