Insider filing report for Changes in Beneficial Ownership
- Schedule 13G & 13D forms are used to report a party's ownership of stock which exceeds 5% of a company's total stock issue.
- Schedule 13G is a shorter version of Schedule 13D with fewer reporting requirements.
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13G
Under the Securities Exchange Act of 1934
(Amendment No. )*
Achilles Therapeutics plc
(Name of Issuer)
American Depositary Shares, each representing one ordinary share, nominal value £0.001 per share
(Title of Class of Securities)
00449L102
(CUSIP Number)
31 DECEMBER 2021
(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
| ☐ | Rule 13d-1(b) |
| ☐ | Rule 13d-1(c) |
| ☒ | Rule 13d-1(d) |
| * | The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page. |
The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
| CUSIP No. 00449L102 |
13G | Page 2 of 6 Pages |
| 1. |
NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY)
Forbion Capital Fund IV Coöperatief U.A. | |||||
| 2. | CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (a) ☐ (b) ☐
| |||||
| 3. | SEC USE ONLY
| |||||
| 4. | CITIZENSHIP OR PLACE OF ORGANIZATION
The Netherlands | |||||
| NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH |
5. | SOLE VOTING POWER
0 | ||||
| 6. | SHARED VOTING POWER
2,390,050 | |||||
| 7. | SOLE DISPOSITIVE POWER
0 | |||||
| 8. | SHARED DISPOSITIVE POWER
2,390,050 | |||||
| 9. |
AGGRE GATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
2,390,050 | |||||
| 10. | CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES
☐ | |||||
| 11. | PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
5.89% (1) | |||||
| 12. | TYPE OF REPORTING PERSON
OO | |||||
| 1 | This percentage is calculated based upon 40,603,489 ordinary shares outstanding as of September 30, 2021, as reported in Exhibit 99.2 to the Issuer’s Report on Form 6-K filed with the Securities and Exchange Commission on November 9, 2021. |
| CUSIP No. 00449L102 |
13G | Page 3 of 6 Pages |
| 1. |
NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY)
Forbion IV Management B.V. | |||||
| 2. | CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (a) ☐ (b) ☐
| |||||
| 3. | SEC USE ONLY
| |||||
| 4. | CITIZENSHIP OR PLACE OF ORGANIZATION
The Netherlands | |||||
| NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH |
5. | SOLE VOTING POWER
0 | ||||
| 6. | SHARED VOTING POWER
2,390,050 | |||||
| 7. | SOLE DISPOSITIVE POWER
0 | |||||
| 8. | SHARED DISPOSITIVE POWER
2,390,050 | |||||
| 9. |
AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
2,390,050 | |||||
| 10. | CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES
☐ | |||||
| 11. | PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
5.89% (2) | |||||
| 12. | TYPE OF REPORTING PERSON
OO | |||||
| 2 | This percentage is calculated based upon 40,603,489 ordinary shares outstanding as of September 30, 2021, as reported in Exhibit 99.2 to the Issuer’s Report on Form 6-K filed with the Securities and Exchange Commission on November 9, 2021. |
| CUSIP No. 00449L102 |
13G | Page 4 of 6 Pages |
| Item 1(a). | Name of Issuer: |
Achilles Therapeutics plc
| Item 1(b). | Address of Issuer’s Principal Executive Offices: |
245 Hammersmith Road, London W6 8PW, United Kingdom
| Item 2(a). | Name of Person Filing: |
This Statement is being filed by Forbion Capital Fund IV Coöperatief U.A. (“Forbion IV COOP”), and Forbion IV Management B.V. (“Forbion IV”), the director of Forbion IV COOP. Forbion IV COOP and Forbion IV are sometimes referred to collectively herein as the “Reporting Persons”.
| Item 2(b). | Address of Principal Business Office or, if None, Residence: |
The address of the principal business and principal office of each of the Reporting Persons is c/o Forbion Capital Partners, Gooimeer 2-35, 1411 DC Naarden, The Netherlands.
| Item 2(c). | Citizenship: |
Forbion Capital Fund IV Coöperatief U.A. – The Netherlands
Forbion IV Management B.V. – The Netherlands
| Item 2(d). | Title of Class of Securities: |
American Depositary Shares, each representing one ordinary share, nominal value £0.001 per share
| Item | 2(e). CUSIP Number: 00449L102 |
| Item 3. | |
| Item 4. | Ownership. |
Forbion IV COOP is the beneficial owner of 2,390,050 American Depositary Shares, each representing one ordinary share (the “Shares”). Forbion IV, the director of Forbion IV COOP, has voting and investment power over the shares held by Forbion IV COOP, which are exercised through Forbion IV’s investment committee, consisting of H. A. Slootweg, M. A. van Osch, G. J. Mulder, H.N. Reithinger, M. Boorsma, V. van Houten and S. J. H. van Deventer. None of the members of the investment committee have individual voting and investment power with respect to such shares, and the members disclaim beneficial ownership of such shares except to the extent of their proportionate pecuniary interests therein.
| (a) | Amount beneficially owned: 2,390,050 |
| (b) | Percent of class: 5.89% |
| CUSIP No. 00449L102 |
13G | Page 5 of 6 Pages |
| (c) | Number of shares as to which such person has: |
| (i) | Sole power to vote or to direct the vote: 0 |
| (ii) | Shared power to vote or to direct the vote: 2,390,050 |
| (iii) | Sole power to dispose or to direct the disposition of: 0 |
| (iv) | Shared power to dispose or to direct the disposition of: 2,390,050 |
| Item 5. | Ownership of Five Percent or Less of a Class. |
Not applicable.
| Item 6. | Ownership of More than Five Percent on Behalf of Another Person. |
Not applicable.
| Item 7. | Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company. |
Not applicable.
| Item 8. | Identification and Classification of Members of the Group. |
The Reporting Persons are making this single, joint filing because they may be deemed to constitute a “group” within the meaning of Section 13(d)(3) of the Securities Exchange Act of 1934, as amended (the “Exchange Act”). The Reporting Persons disclaim membership in a group and this report shall not be deemed an admission by any of the Reporting Persons that they are or may be members of a “group” for purposes of Rule 13d-5 or for any other purpose.
| Item 9. | Notice of Dissolution of Group. |
Not applicable.
| Item 10. | Certification. |
Not applicable .
| CUSIP No. 00449L102 |
13G | Page 6 of 6 Pages |
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
Date: February 11, 2022
| FORBION CAPITAL FUND IV COÖPERATIEF U.A. | ||||||
| By: | /s/ V. van Houten | /s/ H.A. Slootweg | ||||
| Name:V. van Houten | H.A. Slootweg | |||||
| Title: directors of its Director |
||||||
| FORBION IV MANAGEMENT B.V. | ||||||
| By: | /s/ V. van Houten | /s/ H.A. Slootweg | ||||
| Name:V. van Houten | H.A. Slootweg | |||||
| Title: its Directors | ||||||