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 CANAAN PARTNERS |
285 RIVERSIDE AVENUE, SUITE 250 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 05/30/2007
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3. Issuer Name and Ticker or Trading Symbol
AMICUS THERAPEUTICS INC
[ FOLD ]
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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 B Convertible Preferred Stock |
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Common Stock |
931,762 |
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I |
See footnote
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Series C Convertible Preferred Stock |
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Common Stock |
907,498 |
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I |
See footnote
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Series D Convertible Preferred Stock |
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Common Stock |
203,378 |
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I |
See footnote
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Series B Convertible Preferred Stock Warrant (Right to Buy) |
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05/04/2014 |
Series B Convertible Preferred Stock
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14,179 |
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I |
See Footnote
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1. Name and Address of Reporting Person*
C/O CANAAN PARTNERS |
285 RIVERSIDE AVENUE, SUITE 250 |
(Street)
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1. Name and Address of Reporting Person*
C/O CANAAN PARTNERS |
285 RIVERSIDE AVENUE, SUITE 250 |
(Street)
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1. Name and Address of Reporting Person*
C/O CANAAN PARTNERS |
285 RIVERSIDE AVENUE, SUITE 250 |
(Street)
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1. Name and Address of Reporting Person*
C/O CANAAN PARTNERS |
285 RIVERSIDE AVENUE, SUITE 250 |
(Street)
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1. Name and Address of Reporting Person*
C/O CANAAN PARTNERS |
285 RIVERSIDE AVENUE, SUITE 250 |
(Street)
|
1. Name and Address of Reporting Person*
C/O CANAAN PARTNERS |
285 RIVERSIDE AVENUE, SUITE 250 |
(Street)
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1. Name and Address of Reporting Person*
C/O CANAAN PARTNERS |
285 RIVERSIDE AVENUE, SUITE 250 |
(Street)
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1. Name and Address of Reporting Person*
C/O CANAAN PARTNERS |
285 RIVERSIDE AVENUE, SUITE 250 |
(Street)
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1. Name and Address of Reporting Person*
C/O CANAAN PARTNERS |
285 RIVERSIDE AVENUE, SUITE 250 |
(Street)
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1. Name and Address of Reporting Person*
C/O CANAAN PARTNERS |
285 RIVERSIDE AVENUE, SUITE 250 |
(Street)
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Explanation of Responses: |
Remarks: |
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Canaan Equity Partners III LLC
By: /s/ John D. Lambrech, as Attorney-in-Fact |
05/30/2007 |
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05/30/2007 |
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05/30/2007 |
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05/30/2007 |
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* |
05/30/2007 |
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05/30/2007 |
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05/30/2007 |
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05/30/2007 |
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05/30/2007 |
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05/30/2007 |
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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 24.1
LIMITED POWER OF ATTORNEY
FOR SECTION 16 REPORTING OBLIGATIONS
Know all by these presents, that the undersigned hereby makes, constitutes and
appoints each of Guy M. Russo and John D. Lambrech, signing singly and each
acting individually, as the undersigned's true and lawful attorney in fact with
full power and authority as hereinafter described to:
(1) execute for and on behalf of the undersigned, in any capacity, Forms 3,
4, and 5 (including amendments thereto) in accordance with Section 16(a) of the
Securities Exchange Act of 1934 and the rules thereunder (the "Exchange Act");
(2) do and perform any and all acts for and on behalf of the undersigned
which may be necessary or desirable to prepare, complete and execute any such
Form 3, 4, or 5, prepare, complete and execute any amendment or amendments
thereto, and timely deliver and file such form with the United States Securities
and Exchange Commission and any stock exchange or similar authority;
(3) seek or obtain, as the undersigned's representative and on the
undersigned's behalf, information regarding transactions in securities from
any third party, including brokers, employee benefit plan administrators and
trustees, and the undersigned hereby authorizes any such person to release
any such information to such attorney in fact and approves and ratifies any
such release of information; and
(4) 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 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 relieving any of the
undersigned's responsibilities to comply with Section 16 of the Exchange
Act. The undersigned acknowledges that the foregoing attorneys in fact
assume (i) no liability for the undersigned's responsibility to comply
with the requirement of the Exchange Act, (ii) no liability of the
undersigned for any failure to comply with such requirements, or (iii)
no obligation or liability of the undersigned for profit disgorgement
under Section 16(b) of the Exchange Act.
This Power of Attorney shall remain in full force and effect until 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, unless
earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorneys in fact.
* * *
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed as of this 30th day of May, 2007.
CANAAN EQUITY PARTNERS III LLC
By: /s/ Guy M. Russo
---------------------
Name: Guy M. Russo
Title: Manager
CANAAN EQUITY III L.P.
By: Canaan Equity Partners III LLC, its general partner
By: /s/ Guy M. Russo
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Name: Guy M. Russo
Title: Manager
CANAAN EQUITY III ENTREPRENEURS LLC
By: Canaan Equity Partners III LLC, its manager
By: /s/ Guy M. Russo
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Name: Guy M. Russo
Title: Manager
/s/ John V. Balen
- ---------------------
John V. Balen
/s/ Stephen L. Green
- ---------------------
Stephen L. Green
/s/ Deepak Kamra
- ---------------------
Deepak Kamra
/s/ Gregory Kopchinsky
- ---------------------
Gregory Kopchinsky
/s/ Seth A. Rudnick
- ---------------------
Seth A. Rudnick
/s/ Guy M. Russo
- ---------------------
Guy M. Russo
/s/ Eric A. Young
- ---------------------
Eric A. Young
/s/ Stephen Bloch
- ---------------------
Stephen Bloch
Joint Filer Statement
Page 1 of 2
Name of Joint Filers:
Canaan Equity III L.P.
Canaan Equity III Entrepreneurs LLC
John V. Balen
Stephen L. Green
Deepak Kamra
Gregory Kopchinsky
Seth A. Rudnick
Guy M. Russo
Eric A. Young
Address of Joint Filers:
c/o Canaan Partners
285 Riverside Avenue, Suite 250
Westport, CT 06880
Designated Filer:
Canaan Equity Partners III LLC
Issuer and Ticker Symbol:
Amicus Therapeutics, Inc. (FOLD)
Date of Event Requiring Statement:
May 30, 2007
SIGNATURES OF JOINT FILERS
CANAAN EQUITY PARTNERS III LLC
By: *
- ------------------------------------
Name:
Title:
CANAAN EQUITY III L.P.
By: Canaan Equity Partners III LLC, its general partner
By: *
- ------------------------------------
Name:
Title:
Joint Filer Statement
Page 2 of 2
CANAAN EQUITY III ENTREPRENEURS LLC
By: Canaan Equity Partners III LLC, its manager
By: *
- ------------------------------------
Name:
Title:
*
- ------------------------------------
John V. Balen
*
- ------------------------------------
Stephen L. Green
*
- ------------------------------------
Deepak Kamra
*
- ------------------------------------
Gregory Kopchinsky
*
- ------------------------------------
Seth A. Rudnick
*
- ------------------------------------
Guy M. Russo
*
- ------------------------------------
Eric A. Young
* By: /s/ John D. Lambrech
- ------------------------------------
John D. Lambrech, Attorney-in-Fact