View:
Download DOC
Download PDF
Download XLS
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 		 
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
KAKKIS EMIL D
(Last) (First) (Middle)
C/O ULTRAGENYX PHARMACEUTICAL INC.
60 LEVERONI COURT
(Street)
NOVATO CA 94949
(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/30/2014 		3. Issuer Name and Ticker or Trading Symbol
Ultragenyx Pharmaceutical Inc. [ RARE ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
See Remarks
 5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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)
Common Stock 2,552,241 I By Emil Kakkis and Jenny Soriano Living Trust, Dated June 18, 2009
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: 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
Series A Preferred Stock (1) (1) Common Stock 1,956,686(1) (1) D
Warrant to Purchase Series A Preferred Stock (Right to Buy) (2) 06/30/2020 Common Stock 260,688 0.959 D
Warrant to Purchase Series A Preferred Stock (Right to Buy) (2) 06/14/2021 Common Stock 78,206 0.959 D
Warrant to Purchase Series A Preferred Stock (Right to Buy) (2) 06/14/2021 Common Stock 130,344 0.959 D
Stock Option (Right to Buy) (3) 10/31/2023 Common Stock 47,854 6.8646 D
Explanation of Responses:
1. Each share of Series A Convertible Preferred Stock automatically converts into Common Stock on a 1-for-3.1345 basis immediately prior to the closing of the Issuer's initial public offering of Common Stock and has no expiration date. The number of underlying shares of common stock reported in Column 3 does not reflect this 1-for-3.1345 reverse stock split, pursuant to which each share of Series A Convertible Preferred Stock will become convertible into 0.3190 of a share of common stock.
2. Each share of Series A Convertible Preferred Stock automatically converts into Common Stock on a 1-for-3.1345 basis immediately prior to the closing of the Issuer's initial public offering of Common Stock and has no expiration date. The number of underlying shares of common stock reported in Column 3 does not reflect this 1-for-3.1345 reverse stock split, pursuant to which each share of Series A Convertible Preferred Stock will become convertible into 0.3190 of a share of common stock. The warrant became exercisable on June 16, 2011. If the warrant is not exercised prior to the closing of the Company's initial public offering, the warrant will become automatically exercisable for shares of Common Stock instead of shares of Series A Convertible Preferred Stock.
3. 1/4th of the option shall vest one year from November 1, 2013 and then the remaining shares vest monthly until November 1, 2017, provided the Reporting Person has not terminated services with the Issuer.
Remarks:
President and Chief Executive Officer Exhibit List Exhibit 24 - Limited Power of Attorney
By: /s/ Emil D. Kakkis, M.D., Ph.D. 01/30/2014
** 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.
         LIMITED POWER OF ATTORNEY FOR SECTION 16 REPORTING OBLIGATIONS

   Know all by these presents, that the undersigned hereby makes, constitutes
and appoints each of Shalini Sharp and Ryan Murr 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 the undersigned's
capacity as an officer and/or director and/or stockholder of Ultragenyx
Pharmaceutical 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
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 (the "SEC") and any stock exchange or similar authority,
including without limitation the filing of a Form ID or any other application
materials to enable the undersigned to gain or maintain access to the Electronic
Data Gathering, Analysis and Retrieval system of the SEC;

        (3) seek or obtain, as the undersigned's representative and on the
undersigned's behalf, information regarding transactions in the Company's
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, nor is the Company assuming nor relieving, any of the undersigned's
responsibilities to comply with Section 16 of the Exchange Act. The undersigned
acknowledges that neither the Company nor the foregoing attorneys-in-fact assume
(i) any liability for the undersigned's responsibility to comply with the
requirement of the Exchange Act, (ii) any liability of the undersigned for any
failure to comply with such requirements, or (iii) any 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 issued by the Company,
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 January, 2014.

                                        /s/  Emil D. Kakkis, M.D., Ph.D.
                                        -----------------------------------
                                        Signature

                                        Emil D. Kakkis, M.D., Ph.D.
                                        -----------------------------------
                                        Print Name