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 LYELL IMMUNOPHARMA, INC. |
| 400 EAST JAMIE COURT, SUITE 301 |
(Street)
| SOUTH SAN FRANCISCO |
CA |
94080 |
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2. Date of Event Requiring Statement
(Month/Day/Year)
06/16/2021
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3. Issuer Name and Ticker or Trading Symbol
Lyell Immunopharma, Inc.
[ LYEL ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
|
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)
|
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 |
| Option (right to buy) |
|
05/19/2031 |
Common Stock |
400,000 |
14.4 |
D |
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| Explanation of Responses: |
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| Remarks: |
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/s/ Heather D. Turner, as Attorney-in-fact |
06/16/2021 |
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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
Know all by these presents that the undersigned hereby constitutes and
appoints Heather Turner Charles Newton and Hector Casab of Lyell Immunopharma
Inc. and Lauren Creel and Allison Peth of Cooley LLP or any of them signing
singly with full power of substitution the undersigned's true and lawful
attorney in fact to:
(1) execute for and on behalf of the undersigned in the undersigned's capacity
as an officer director or beneficial owner of more than 10% of a registered
class of securities of Lyell Immunopharma Inc. (the "Company") Forms 3 4 and 5
(including any amendments thereto) in accordance with Section 16(a) of the
Securities Exchange Act of 1934 as amended (the "Exchange Act") and the rules
thereunder and a Form ID Uniform Application for Access Codes to File on EDGAR;
(2) do and perform any and all acts for and on behalf of the undersigned that
may be necessary or desirable to execute such Forms 3 4 or 5 or Form ID
(including any amendments thereto) and timely file such forms with the United
States Securities and Exchange Commission and any stock exchange or similar
authority; and
(3) take any other action of any nature whatsoever in connection with the
foregoing which in the opinion of such attorney-in-fact may be of benefit 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 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 such 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 that 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 power of attorney and the rights and powers herein
granted. The undersigned acknowledges that the foregoing attorneys-in-fact in
serving in such capacity at the request of the undersigned are not assuming nor
is the Company assuming any of the undersigned's responsibilities to comply with
Section 16 of the Exchange Act.
This Power of Attorney shall remain in full force and effect until the
earliest to occur of (a) the undersigned is no longer required to file Forms 3 4
and 5 with respect to the undersigned's holdings of and transactions in
securities issued by the Company (b) revocation by the undersigned in a signed
writing delivered to the foregoing attorneys-in-fact or (c) as to any
attorney-in-fact individually until such attorney-in-fact is no longer employed
by the Company or Cooley LLP.
IN WITNESS WHEREOF the undersigned has caused this Power of Attorney to
be executed as of this 2nd day of June 2021.
/s/ Lynn Seely M.D.
Lynn Seely M.D.
1
