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 PRECISION BIOSCIENCES, INC. |
| 302 E. PETTIGREW STREET, SUITE A-100 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
03/27/2019
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3. Issuer Name and Ticker or Trading Symbol
PRECISION BIOSCIENCES INC
[ DTIL ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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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)
| X |
Form filed by One Reporting Person |
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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 |
| Stock Option (Right to Buy) |
|
12/04/2028 |
Common Stock |
147,562 |
13.2 |
D |
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| Explanation of Responses: |
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| Remarks: |
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/s/ Abid Ansari, Attorney-in-Fact for Shalini Sharp |
03/27/2019 |
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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. |
LIMITED POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby makes, constitutes and
appoints Michael P. Saber, Heyward D. Armstrong, Amanda L. Keister, and Abid
Ansari, and each of them singly, as the undersigned's true and lawful
attorneys-in-fact with full power and authority as hereinafter described to:
1. execute for and on behalf of the undersigned, in the undersigned's capacity
as an officer, director and/or stockholder of Precision BioSciences, Inc. (the
"Company"), (i) Forms 3, 4, and 5 (including amendments thereto) in accordance
with Section 16(a) of the Securities Exchange Act of 1934, as amended (the
"Exchange Act"), and the rules thereunder, (ii) Form 144 in accordance with Rule
144 under the Securities Act of 1933, as amended (the "Securities Act"), and
(iii) Schedules 13D and 13G (including amendments thereto) in accordance with
Sections 13(d) and 13(g) of the Exchange Act and the rules thereunder;
2. do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable to complete and execute any such Form 3, 4, or 5
(including amendments thereto), Form 144, or Schedule 13D or 13G (including
amendments thereto) and timely file such form with the United States Securities
and Exchange Commission (the "SEC") and any stock exchange or similar authority,
including, but not limited to, executing a Form ID for and on behalf of the
undersigned and filing such Form ID with the SEC; and
3. take any other action of any type whatsoever in connection with the foregoing
which, in the opinion of such attorney-in-fact, may be of benefit to, in the
best interest of, or legally required by, the undersigned, it being understood
that the documents executed by such attorney-in-fact on behalf of the
undersigned pursuant to this Limited Power of Attorney shall be in such form and
shall contain such terms and conditions as such attorney-in-fact may approve in
such attorney-in-fact's discretion.
The undersigned hereby grants to each attorney-in-fact full power and authority
to do and perform any and every act and thing whatsoever requisite, necessary,
or proper to be done in the exercise of any of the rights and powers herein
granted, as fully to all intents and purposes as the undersigned might or could
do if personally present, with full power of substitution or revocation, hereby
ratifying and confirming all the acts such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be
done by virtue of this Limited Power of Attorney and the rights and powers
herein granted. The undersigned acknowledges that each of the foregoing
attorneys-in-fact, in serving in such capacity at the request of the
undersigned, is not assuming any of the undersigned's responsibilities to comply
with Sections 13 or 16 of the Exchange Act or Rule 144 under the Securities Act.
The undersigned hereby revokes any and all prior powers of attorney executed for
this purpose. This Limited Power of Attorney shall remain in full force and
effect until the undersigned is no longer required to file Forms 3, 4, and 5
(including amendments thereto), Form 144, and Schedules 13D and 13G (including
amendments thereto) with respect to the undersigned's holdings of and
transactions in securities issued by the Company, unless earlier revoked by the
undersigned in a signed writing delivered to each of the foregoing
attorneys-in-fact. In addition, at such time as any attorney-in-fact (i) ceases
to serve as an employee or counsel of the Company or any subsidiary of the
Company or (ii) resigns as attorney-in-fact by the execution of a written
resignation delivered to the undersigned or the Company, without any action on
the part of the undersigned, this Limited Power of Attorney shall be partially
revoked solely with respect to such individual; such individual shall cease to
be an attorney-in-fact under this Limited Power of Attorney; and the authority
of the other attorneys-in-fact then existing hereunder shall remain in full
force and effect.
IN WITNESS WHEREOF, the undersigned has caused this Limited Power of Attorney to
be executed as of this 31st day of December, 2018.
By: /s/ Shalini Sharp
Print Name: Shalini Sharp
