Filing Details
- Accession Number:
- 0000904454-11-000617
- Form Type:
- 4
- Zero Holdings:
- No
- Publication Time:
- 2011-11-21 20:23:31
- Reporting Period:
- 2011-11-21
- Filing Date:
- 2011-11-21
- Filing Date Changed:
- 2011-11-21
- Accepted Time:
- 2011-11-21 20:23:31
- Original Submission Date:
Issuer
| Cik | Name | Symbol | Sector (SIC) | IRS No |
|---|---|---|---|---|
| 1466301 | Clovis Oncology, Inc. | CLVS | Pharmaceutical Preparations (2834) | 900475355 |
Insiders
| Cik | Name | Reported Address | Insider Title | Director | Officer | Large Shareholder | Other |
|---|---|---|---|---|---|---|---|
| 1024000 | C James Blair | C/o Domain Associates, Llc One Palmer Square Princeton NJ 08542 |
Yes | No | Yes | No |
Reported Non-Derivative Transactions
| Sec. Name | Acquisiton - Disposition | Date | Amount | Price | Remaning Holdings |
|---|---|---|---|---|---|
| Common Stock | Acquisiton | 2011-11-21 | 409,192 | $0.00 | 409,192 |
| Common Stock | Acquisiton | 2011-11-21 | 409,192 | $0.00 | 818,384 |
| Common Stock | Acquisiton | 2011-11-21 | 885,696 | $0.00 | 1,704,080 |
| Common Stock | Acquisiton | 2011-11-21 | 370,799 | $0.00 | 2,074,879 |
| Common Stock | Acquisiton | 2011-11-21 | 916,058 | $13.00 | 2,990,937 |
| Common Stock | Acquisiton | 2011-11-21 | 6,979 | $0.00 | 6,979 |
| Common Stock | Acquisiton | 2011-11-21 | 6,979 | $0.00 | 13,958 |
| Common Stock | Acquisiton | 2011-11-21 | 15,106 | $0.00 | 29,064 |
| Common Stock | Acquisiton | 2011-11-21 | 6,324 | $0.00 | 35,388 |
| Common Stock | Acquisiton | 2011-11-21 | 15,625 | $13.00 | 51,013 |
| Equity Swap Involved | Form Type | Code | Nature of Ownership | Explanation |
|---|---|---|---|---|
| No | 4 | C | Indirect | By Domain Partners VII, L.P. |
| No | 4 | C | Indirect | By Domain Partners VII, L.P. |
| No | 4 | C | Indirect | By Domain Partners VII, L.P. |
| No | 4 | C | Indirect | By Domain Partners VII, L.P. |
| No | 4 | P | Indirect | By Domain Partners VII, L.P. |
| No | 4 | C | Indirect | By DP VII Associates, L.P. |
| No | 4 | C | Indirect | By DP VII Associates, L.P. |
| No | 4 | C | Indirect | By DP VII Associates, L.P. |
| No | 4 | C | Indirect | By DP VII Associates, L.P. |
| No | 4 | P | Indirect | By DP VII Associates, L.P. |
Reported Derivative Transactions
| Sec. Name | Sec. Type | Acquisiton - Disposition | Date | Amount | Price | Amount - 2 | Price - 2 |
|---|---|---|---|---|---|---|---|
| Common Stock | Series A-1 Preferred Stock | Disposition | 2011-11-21 | 1,186,657 | $0.00 | 409,192 | $0.00 |
| Common Stock | Series A-2 Preferred Stock | Disposition | 2011-11-21 | 1,186,657 | $0.00 | 409,192 | $0.00 |
| Common Stock | Series B Preferred Stock | Disposition | 2011-11-21 | 2,568,521 | $0.00 | 885,696 | $0.00 |
| Common Stock | Convertible Promissory Note | Disposition | 2011-11-21 | 0 | $0.00 | 370,799 | $0.00 |
| Common Stock | Series A-1 Preferred Stock | Disposition | 2011-11-21 | 20,240 | $0.00 | 6,979 | $0.00 |
| Common Stock | Series A-2 Preferred Stock | Disposition | 2011-11-21 | 20,240 | $0.00 | 6,979 | $0.00 |
| Common Stock | Series B Preferred Stock | Disposition | 2011-11-21 | 43,809 | $0.00 | 15,106 | $0.00 |
| Common Stock | Convertible Promissory Note | Disposition | 2011-11-21 | 0 | $0.00 | 6,324 | $0.00 |
| Remaning Holdings | Exercise Date | Expiration Date | Equity Swap Involved | Transaction Form Type | Transaction Code | Nature of Ownership |
|---|---|---|---|---|---|---|
| 0 | No | 4 | C | Indirect | ||
| 0 | No | 4 | C | Indirect | ||
| 0 | No | 4 | C | Indirect | ||
| 0 | No | 4 | C | Indirect | ||
| 0 | No | 4 | C | Indirect | ||
| 0 | No | 4 | C | Indirect | ||
| 0 | No | 4 | C | Indirect | ||
| 0 | No | 4 | C | Indirect |
Footnotes
- All outstanding shares of the Issuer's preferred stock were automatically converted into Common Stock upon the closing of the Issuer's initial public offering (the "IPO"), for no additional consideration.
- The Convertible Promissory Note, plus interest accrued thereon through the closing of the IPO, automatically converted into Common Stock upon the closing of the IPO, based on the IPO price of $13.00 per share.
- The Reporting Person also indirectly beneficially owns 32,758 shares of Common Stock held by Domain Associates, LLC. The Reporting Person is a Managing Member of One Palmer Square Associates VII, LLC, which is the sole general partner of Domain Partners VII, L.P. and DP VII Associates, L.P. and Domain Associates, LLC. Pursuant to Instruction (4)(b)(iv) of Form 4, the Reporting Person has elected to report as indirectly beneficially owned the entire number of securities beneficially owned by each such entity. The Reporting Person disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his or her pecuniary interest therein and/or that are not actually distributed to him or her.
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