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)
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2. Date of Event Requiring Statement
(Month/Day/Year) 03/10/2004 |
3. Issuer Name and Ticker or Trading Symbol
XCYTE THERAPIES INC [ XCYT ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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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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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) |
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 | ||||
6% Convertible Promissory Note | 03/10/2004 | 04/30/2004(12) | Common Stock | 1,428(13) | 9.625(12) | D | |
Series A Convertible Preferred Stock | 03/10/2004 | (1) | Common Stock | 143,539(13) | (1) | I | Footnote(2) |
Series B Convertible Preferred Stock | 03/10/2004 | (1) | Common Stock | 371,900(13) | (1) | I | Footnote(3) |
Series C Convertible Preferred Stock | 03/10/2004 | (1) | Common Stock | 203,502(13) | (1) | I | Footnote(4) |
Series D Convertible Preferred Stock | 03/10/2004 | (1) | Common Stock | 240,352(13) | (1) | I | Footnote(5) |
Series E Convertible Preferred Stock | 03/10/2004 | (1) | Common Stock | 170,045(13) | (1) | I | Footnote(6) |
Series F Convertible Preferred Stock | 03/10/2004 | (1) | Common Stock | 163,473(13) | (1) | I | Footnote(14) |
Warrants to purchase Common Stock | 03/16/2004 | 02/04/2007(11) | Common Stock | 89,002(13) | 0.055(11) | I | Footnote(15) |
Warrants to purchase Series A Convertible Preferred Stock | 03/16/2004 | 08/31/2007(7) | Series A Covertible Preferred Stock/Common Stock | 50,237(13) | 5.225(7) | I | Footnote(7) |
Warrants to purchase Common Stock | 03/16/2004 | 08/08/2005(8) | Common Stock | 26,918(13) | 1.65(8) | I | Footnote(8) |
Warrants to purchase Common Stock | 03/16/2004 | 11/12/2006(9) | Common Stock | 92,580(13) | 0.055(9) | I | Footnote(9) |
6% Convertible Promissory Notes | 03/10/2004 | 04/30/2004(10) | Common Stock | 352,895(13) | 9.625(10) | I | Footnote(10) |
Explanation of Responses: |
1. These securities are preferred stock of Xcyte Therapies, Inc. and do not have an expiration date. Each share of its preferred stock will convert automatically into one share of common stock upon the closing of the initial public offering. |
2. Represents securities held by ARCH Venture Fund II, L.P. and ARCH Venture Fund III, L.P., both are affiliated entities of the Reporting Person. ARCH Venture Fund II, L.P. holds 114,832 shares of common stock upon conversion of preferred stock while ARCH Venture Fund III, L.P. holds 28,707 shares of common stock upon conversion of preferred stock. |
3. Represents securities held by ARCH Venture Fund II, L.P. and ARCH Venture Fund III, L.P., both are affiliated entities of the Reporting Person. ARCH Venture Fund II, L.P. holds 66,115 shares of common stock upon conversion of preferred stock while ARCH Venture Fund III, L.P. holds 305,785 shares of common stock upon conversion of preferred stock. |
4. Represents securities held by ARCH Venture Fund III, L.P., an affiliated entity of the Reporting Person. Represents 203,502 shares of common stock upon conversion of preferred stock. |
5. Represents securities held by ARCH Venture Fund III, L.P., an affiliated entity of the Reporting Person. Represents 240,352 shares of common stock upon conversion of preferred stock. |
6. Represents securities held by ARCH Venture Fund III, L.P., an affiliated entity of the Reporting Person. Represents 170,045 shares of common stock upon conversion of preferred stock. |
7. Represents securities held by ARCH Venture Fund III, L.P., an affiliated entity of the Reporting Person. Represents a warrant to purchase 50,237 shares of preferred stock which would convert to common stock upon the closing of initial public offering. Warrant is exercisable at the earlier of the closing of an initial public offering or its expiration date. |
8. Represents securities held by ARCH Venture Fund III, L.P., an affiliated entity of the Reporting Person. Represents a warrant to purchase 26,918 shares of common stock. Warrant is exercisable at the earlier of a closing of an initial public offering or its expiration date. |
9. Represents securities held by ARCH Venture Fund III, L.P., an affiliated entity of the Reporting Person. Represents a warrant to purchase 92,580 shares of common stock. Warrant is exercisable at the earlier of a closing of an initial public offering or its expiration date. |
10. Represents promissory notes at 6% held by ARCH Venture Fund III, L.P. (AVFIII), Healthcare Focus Fund, L.P. (HFF) and ARCH Venture Fund V, L.P. (AVFV), each of which is an affiliated entity of the Reporting Person. Interest and principal convertible into shares of common stock at the closing of the initial public offering. AVFIII holds 61,333 shares of common stock upon conversion of promissory notes, HFF holds 80,000 shares of common stock upon conversion of promissory notes and AVFV holds 211,905 shares of common stock upon conversion of promissory notes. AVFIII, HFF, and AVFV each holds a warrant for common stock; however, these warrants are null and void if the company completes its initial public offering, and as such are not reported. |
11. Warrant is exercisable at the earlier of a closing of an initial public offering or its expiration date. The reporting person disclaims beneficial ownership of such securities except to the extent of their pecuniary interest therein. |
12. Represents a promissory note at 6%; interest and principal convertible into shares of common stock at the closing of the initial public offering at $9.625 per share. The reporting person also holds 219 warrants to purchase common stock; however, the warrants are null and void if the company completes its initial public offering, and as such are not reported. The reporting person disclaims beneficial ownership of such securities except to the extent of their pecuniary interest therein, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such shares of common stock. |
13. Share amounts reflect a 5.5 to 1 reverse stock split effective immediately prior to the closing of the initial public offering. |
14. Represents securities held by Healthcare Fund, L.P., an affiliated entity of the Reporting Person. Represents 163,473 shares of common stock upon conversion of preferred stock. |
15. Represents securities held by Healthcare Fund, L.P., an affiliated entity of the Reporting Person. Represents a warrant to purchase 89,002 shares of common stock. |
ARCH V Entrepreneurs Fund, L.P., By: ARCH Venture Partners V, L.P., Its: General Partner, By: ARCH Venture Partners V, LLC, Its: General Partner, By: Keith Crandell, Managing Director, By:/s/Keith Crandell | 03/10/2004 | |
** 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. |