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 NOVARTIS VENTURE FUND |
FORUM 1 - 1.32, LICHTSTRASSE 35 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 11/06/2019
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3. Issuer Name and Ticker or Trading Symbol
Galera Therapeutics, Inc.
[ GRTX ]
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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 |
1,779,864 |
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I |
See footnote
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Series B Preferred Stock |
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Common Stock |
1,423,891 |
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I |
See footnote
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Series C Preferred Stock |
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Common Stock |
89,311 |
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I |
See footnote
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1. Name and Address of Reporting Person*
C/O NOVARTIS VENTURE FUND |
FORUM 1 - 1.32, LICHTSTRASSE 35 |
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
Remarks: |
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Novartis Bioventures Ltd., By: /s/ Bart Dzikowski, Name: Bart Dzikowski, Title: Secretary of the Board, By: /s/ Stephan Sandmeier, Name: Stephan Sandmeier, Title: Authorized Signatory |
11/06/2019 |
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Novartis AG, By: /s/ Bart Dzikowski, Name: Bart Dzikowski, Title: Attorney-in-Fact, By: /s/ Stephan Sandmeier, Name: Stephan Sandmeier, Title: Attorney-in-Fact |
11/06/2019 |
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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. |
EXHIBIT 24
POWER OF ATTORNEY
We, the undersigned, under the authority granted to each of us to sign
jointly on behalf of Novartis AG, hereby grant powers to Bart Dzikowski, Anja
Koenig, Stephan Sandmeier, Florian Muellershausen, Beat Steffen, Marc Ceulemans
and Florent Gros and constitute and appoint any two of them jointly as our true
and lawful attorneys and representatives and to act on our behalf and to sign
filings to be made with the U.S. Securities and Exchange Commission (the "SEC")
relating to the shares of Galera Therapeutics, Inc. (the "Company") held by
Novartis Bioventures Ltd., an indirect subsidiary of Novartis AG, as required by
the SEC (the "SEC Filings"), and to undertake and carry out all tasks and
formalities on our behalf which may be required in connection with giving effect
to the SEC Filings.
We, the undersigned, undertake to ratify and confirm whatever our true and
lawful attorneys do or purport to do in good faith in the exercise of any power
conferred by this Power of Attorney.
We, the undersigned, declare that a person who deals with our true and lawful
attorneys in good faith may accept a written statement signed by such attorneys
to the effect that this Power of Attorney has not been revoked as
conclusive evidence of that fact.
The authority granted by this Power of Attorney shall expire immediately after
the SEC Filings are no longer required.
IN WITNESS WHEREOF, this Power of Attorney is duly signed on this 21 day of
February 2019.
Novartis AG
/s/ K. Roth Pellanda
Name: Katja Roth Pellanda
Title: Authorized Signatory
/s/ C. Rehm
Name: Christian Rehm
Title: Authorized Signatory