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*
1700 OWENS STREET |
SUITE 500 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 02/12/2020
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3. Issuer Name and Ticker or Trading Symbol
Revolution Medicines, Inc.
[ RVMD ]
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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 Preferred Stock |
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Common Stock |
5,137,583
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D
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Series B Preferred Stock |
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Common Stock |
2,740,043
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D
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Series C Preferred Stock |
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Common Stock |
99,758
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D
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1. Name and Address of Reporting Person*
1700 OWENS STREET |
SUITE 500 |
(Street)
|
1. Name and Address of Reporting Person*
1700 OWENS STREET |
SUITE 500 |
(Street)
|
1. Name and Address of Reporting Person*
1700 OWENS STREET |
SUITE 500 |
(Street)
|
1. Name and Address of Reporting Person*
1700 OWENS STREET |
SUITE 500 |
(Street)
|
1. Name and Address of Reporting Person*
1700 OWENS STREET |
SUITE 500 |
(Street)
|
1. Name and Address of Reporting Person*
1700 OWENS STREET |
SUITE 500 |
(Street)
|
1. Name and Address of Reporting Person*
1700 OWENS STREET |
SUITE 500 |
(Street)
|
1. Name and Address of Reporting Person*
1700 OWENS STREET |
SUITE 500 |
(Street)
|
1. Name and Address of Reporting Person*
1700 OWENS STREET |
SUITE 500 |
(Street)
|
1. Name and Address of Reporting Person*
1700 OWENS STREET |
SUITE 500 |
(Street)
|
Explanation of Responses: |
Remarks: |
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/s/ Jennifer J. Carlson, Attorney-in-Fact |
02/12/2020 |
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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. |
EX-24.1
Power of Attorney
The undersigned, a managing partner of The Column Group III, LP, hereby
constitutes and appoints each of Gary A. Jungels, Jennifer J. Carlson, Christine
McDevitt, Molly Gray and Leslie Schmidt, for so long as they are affiliated with
a law firm representing The Column Group, LLC, the undersigned's true and lawful
attorney-in-fact, each with the power to act alone for the undersigned and in
the undersigned's name, place and stead, to:
1. Prepare, complete and execute an SEC Form ID required by Sections 13(a) and
23(a) of the Securities Exchange Act of 1934, as amended (the "Exchange Act"),
and the rules and regulations promulgated thereunder, and any and all amendments
thereto, and any other documents necessary or appropriate in order to obtain
EDGAR access codes, and to file or cause to be filed the same with the
Securities and Exchange Commission as may be required or advisable;
2. Prepare, complete and execute Forms 3, 4 and 5 under the Exchange Act and
other forms and all amendments thereto on the undersigned's behalf as such
attorney-in-fact shall in his or her discretion determine to be required or
advisable pursuant to Section 16 or Section 13 of the Exchange Act and the rules
and regulations promulgated thereunder, or any successor laws and regulations,
as a consequence of the undersigned's beneficial ownership of securities or
changes in such beneficial ownership; and
3. Do all acts necessary in order to file such forms and amendments with the
Securities and Exchange Commission, any securities exchange or national
association and such other persons or agencies as the attorney-in-fact shall
deem appropriate.
The undersigned hereby ratifies and confirms all that said attorneys-in-fact and
agents shall do or cause to be done by virtue hereof. The undersigned
acknowledges that the foregoing attorneys-in-fact, in serving in such capacity
at the request of the undersigned, are not assuming any of the undersigned's
responsibilities to comply with or liability under Section 16 or Section 13 of
the Exchange Act or any rules and regulations promulgated thereunder or any
successor laws and regulations.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, or 5 or such other forms
and amendments thereto pursuant to Section 16 or Section 13 of the Exchange Act
with respect to the undersigned's beneficial ownership of securities or changes
in such beneficial ownership, unless earlier revoked by the undersigned in a
signed writing delivered to the foregoing attorneys-in-fact.
The undersigned has executed this Power of Attorney as of October 9, 2019.
/s/ Peter Svennilson
Managing Partner
EX-24.2
Power of Attorney
The undersigned, a managing partner of The Column Group III-A, LP, hereby
constitutes and appoints each of Gary A. Jungels, Jennifer J. Carlson, Christine
McDevitt, Molly Gray and Leslie Schmidt, for so long as they are affiliated with
a law firm representing The Column Group, LLC, the undersigned's true and lawful
attorney-in-fact, each with the power to act alone for the undersigned and in
the undersigned's name, place and stead, to:
1. Prepare, complete and execute an SEC Form ID required by Sections 13(a) and
23(a) of the Securities Exchange Act of 1934, as amended (the "Exchange Act"),
and the rules and regulations promulgated thereunder, and any and all amendments
thereto, and any other documents necessary or appropriate in order to obtain
EDGAR access codes, and to file or cause to be filed the same with the
Securities and Exchange Commission as may be required or advisable;
2. Prepare, complete and execute Forms 3, 4 and 5 under the Exchange Act and
other forms and all amendments thereto on the undersigned's behalf as such
attorney-in-fact shall in his or her discretion determine to be required or
advisable pursuant to Section 16 or Section 13 of the Exchange Act and the rules
and regulations promulgated thereunder, or any successor laws and regulations,
as a consequence of the undersigned's beneficial ownership of securities or
changes in such beneficial ownership; and
3. Do all acts necessary in order to file such forms and amendments with the
Securities and Exchange Commission, any securities exchange or national
association and such other persons or agencies as the attorney-in-fact shall
deem appropriate.
The undersigned hereby ratifies and confirms all that said attorneys-in-fact and
agents shall do or cause to be done by virtue hereof. The undersigned
acknowledges that the foregoing attorneys-in-fact, in serving in such capacity
at the request of the undersigned, are not assuming any of the undersigned's
responsibilities to comply with or liability under Section 16 or Section 13 of
the Exchange Act or any rules and regulations promulgated thereunder or any
successor laws and regulations.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, or 5 or such other forms
and amendments thereto pursuant to Section 16 or Section 13 of the Exchange Act
with respect to the undersigned's beneficial ownership of securities or changes
in such beneficial ownership, unless earlier revoked by the undersigned in a
signed writing delivered to the foregoing attorneys-in-fact.
The undersigned has executed this Power of Attorney as of October 9, 2019.
/s/ Peter Svennilson
Managing Partner
EX-24.3
Power of Attorney
The undersigned, a managing partner of The Column Group III GP, LP, hereby
constitutes and appoints each of Gary A. Jungels, Jennifer J. Carlson, Christine
McDevitt, Molly Gray and Leslie Schmidt, for so long as they are affiliated with
a law firm representing The Column Group, LLC, the undersigned's true and lawful
attorney-in-fact, each with the power to act alone for the undersigned and in
the undersigned's name, place and stead, to:
1. Prepare, complete and execute an SEC Form ID required by Sections 13(a) and
23(a) of the Securities Exchange Act of 1934, as amended (the "Exchange Act"),
and the rules and regulations promulgated thereunder, and any and all amendments
thereto, and any other documents necessary or appropriate in order to obtain
EDGAR access codes, and to file or cause to be filed the same with the
Securities and Exchange Commission as may be required or advisable;
2. Prepare, complete and execute Forms 3, 4 and 5 under the Exchange Act and
other forms and all amendments thereto on the undersigned's behalf as such
attorney-in-fact shall in his or her discretion determine to be required or
advisable pursuant to Section 16 or Section 13 of the Exchange Act and the rules
and regulations promulgated thereunder, or any successor laws and regulations,
as a consequence of the undersigned's beneficial ownership of securities or
changes in such beneficial ownership; and
3. Do all acts necessary in order to file such forms and amendments with the
Securities and Exchange Commission, any securities exchange or national
association and such other persons or agencies as the attorney-in-fact shall
deem appropriate.
The undersigned hereby ratifies and confirms all that said attorneys-in-fact and
agents shall do or cause to be done by virtue hereof. The undersigned
acknowledges that the foregoing attorneys-in-fact, in serving in such capacity
at the request of the undersigned, are not assuming any of the undersigned's
responsibilities to comply with or liability under Section 16 or Section 13 of
the Exchange Act or any rules and regulations promulgated thereunder or any
successor laws and regulations.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, or 5 or such other forms
and amendments thereto pursuant to Section 16 or Section 13 of the Exchange Act
with respect to the undersigned's beneficial ownership of securities or changes
in such beneficial ownership, unless earlier revoked by the undersigned in a
signed writing delivered to the foregoing attorneys-in-fact.
The undersigned has executed this Power of Attorney as of October 9, 2019.
/s/ Peter Svennilson
Managing Partner