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*
C/O SOFINNOVA INVESTMENTS, INC. |
3000 SAND HILL ROAD, BLDG. 4, SUITE 250 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 05/13/2021
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3. Issuer Name and Ticker or Trading Symbol
Vera Therapeutics, Inc.
[ VERA ]
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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 C Preferred Stock |
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Class A Common Stock |
2,187,504 |
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D
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1. Name and Address of Reporting Person*
C/O SOFINNOVA INVESTMENTS, INC. |
3000 SAND HILL ROAD, BLDG. 4, SUITE 250 |
(Street)
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1. Name and Address of Reporting Person*
C/O SOFINNOVA INVESTMENTS, INC. |
3000 SAND HILL ROAD, BLDG. 4, SUITE 250 |
(Street)
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1. Name and Address of Reporting Person*
C/O SOFINNOVA INVESTMENTS, INC. |
3000 SAND HILL ROAD, BLDG. 4, SUITE 250 |
(Street)
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1. Name and Address of Reporting Person*
C/O SOFINNOVA INVESTMENTS, INC. |
3000 SAND HILL ROAD, BLDG. 4, SUITE 250 |
(Street)
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Explanation of Responses: |
Remarks: |
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/s/ Nathalie Auber, as attorney-in-fact for Sofinnova Venture Partners X, L.P. |
05/13/2021 |
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/s/ Nathalie Auber, as attorney-in-fact for Sofinnova Management X, L.L.C. |
05/13/2021 |
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/s/ Nathalie Auber, as attorney-in-fact for James I. Healy |
05/13/2021 |
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/s/ Nathalie Auber, as attorney-in-fact for Michael F. Powell |
05/13/2021 |
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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. |
Power of Attorney
Each of the undersigned entities and individuals (collectively, the "Reporting
Persons") hereby authorizes and designates Sofinnova Management X, L.L.C. or
such other person or entity as is designated in writing by James I. Healy (the
"Designated Filer") as the beneficial owner to prepare and file on behalf of
such Reporting Person individually, or jointly together with the other Reporting
Persons, any and all reports, notices, communications and other documents
(including, but not limited to, reports on Schedule 13D, Schedule 13G, Form 3,
Form 4 and Form 5) that such Reporting Person may be required to file with the
United States Securities and Exchange Commission pursuant to the Securities Act
of 1933, as amended (together with the implementing regulations thereto, the
"Act") and the Securities Exchange Act of 1934, as amended (together with the
implementing regulations thereto, the "Exchange Act") (collectively, the
"Reports") with respect to each Reporting Person's ownership of, or transactions
in, securities of any entity whose securities are beneficially owned (directly
or indirectly) by such Reporting Person (collectively, the "Companies").
Each Reporting Person hereby further authorizes and designates Nathalie Auber
(the "Authorized Signatory") to execute and file on behalf of such Reporting
Person the Reports and to perform any and all other acts, which in the opinion
of the Designated Filer or Authorized Signatory may be necessary or incidental
to the performance of the foregoing powers herein granted.
The authority of the Designated Filer and the Authorized Signatory under this
Document with respect to each Reporting Person shall continue until such
Reporting Person is no longer required to file any Reports with respect to the
Reporting Person's ownership of, or transactions in, the securities of the
Companies, unless earlier revoked in writing. Each Reporting Person
acknowledges that the Designated Filer and the Authorized Signatory are not
assuming any of the Reporting Person's responsibilities to comply with the Act
or the Exchange Act.
Date: June 25, 2020
SOFINNOVA VENTURE PARTNERS X, L.P.,
a Delaware Limited Partnership
By: SOFINNOVA MANAGEMENT X, L.L.C.,
a Delaware Limited Liability Company
Its General Partner
By: /s/ James I. Healy
James I. Healy
Managing Member
SOFINNOVA MANAGEMENT X, L.L.C.,
a Delaware Limited Liability Company
By: /s/ James I. Healy
James I. Healy
Managing Member
JAMES I. HEALY
By: /s/ James I. Healy
James I. Healy
MAHA KATABI
By: /s/ Maha Katabi
Maha Katabi
MICHAEL F. POWELL
By: /s/ Michael F. Powell
Michael F. Powell