Initial Statement of Beneficial Ownership (3)
26 November 2019 - 8:34AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
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3235-0104
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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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1. Name and Address of Reporting Person
*
King-Jones Heidy |
2. Date of Event Requiring Statement (MM/DD/YYYY)
11/13/2019
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3. Issuer Name and Ticker or Trading Symbol
Axcella Health Inc. [AXLA]
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(Last)
(First)
(Middle)
C/O AXCELLA HEALTH INC., 840 MEMORIAL DRIVE |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) General Counsel, SVP Legal / |
(Street)
CAMBRIDGE, MA 02139
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Option (Right to Buy) | (1) | 2/6/2028 | Common Stock | 46145 | $6.52 | D | |
Stock Option (Right to Buy) | (2) | 3/11/2029 | Common Stock | 16286 | $13.83 | D | |
Explanation of Responses: |
(1) | 25% of this option vested and became exercisable on January 2, 2019, with the remainder vesting in 12 equal quarterly installments thereafter. |
(2) | 25% of this option shall vest and become exercisable on March 1, 2020, with the remainder vesting in 12 equal quarterly installments thereafter. |
Remarks: Exhibit 24 - Power of Attorney |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
King-Jones Heidy C/O AXCELLA HEALTH INC. 840 MEMORIAL DRIVE CAMBRIDGE, MA 02139 |
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| General Counsel, SVP Legal |
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Signatures
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/s/ Heidy King-Jones | | 11/25/2019 |
**Signature of Reporting Person | Date |
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