SEC 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
|Estimated average burden|
|hours per response:
1. Name and Address of Reporting Person*
|C/O SAGE THERAPEUTICS, INC.|
|215 FIRST STREET|
2. Date of Event Requiring Statement
3. Issuer Name and Ticker or Trading Symbol
Sage Therapeutics, Inc.
[ SAGE ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
5. If Amendment, Date of Original Filed
6. Individual or Joint/Group Filing (Check Applicable Line)
||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.
Amount of Securities Beneficially Owned (Instr.
||3. Ownership Form: Direct (D) or Indirect (I) (Instr.
||4. Nature of Indirect Beneficial Ownership (Instr.
Table II - Derivative Securities Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Date Exercisable and Expiration Date
||3. Title and Amount of Securities Underlying Derivative Security (Instr.
||4. Conversion or Exercise Price of Derivative Security
||5. Ownership Form: Direct (D) or Indirect (I) (Instr.
||6. Nature of Indirect Beneficial Ownership (Instr.
||Amount or Number of Shares
|Explanation of Responses:|
|No securities are beneficially owned.|
||/s/ Jennifer Fitzpatrick, as Attorney-in-Fact for George Golumbeski
||** Signature of Reporting Person
|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,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
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,
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
I, the undersigned, hereby authorize and designate Anne Marie
Cook (SVP, General Counsel), Kimi Iguchi (Chief Financial Officer)
and Jennifer Fitzpatrick (VP, Corporate Counsel) for as
long as they remain employees of Sage Therapeutics, Inc., and
Laurie Burlingame of Goodwin Procter, each acting singly, or their
successors in role, to take the following actions, acting as
my agent and attorney-in-fact, with full power of substitution:
(1) to prepare and sign on my behalf any Form 3, Form 4 or
Form 5 pursuant to Section 16 of the Securities Exchange Act of 1934,
as amended, and to file the same with the Securities and Exchange
Commission, NASDAQ, NYSE, and each stock exchange on which shares of
Common Stock or other securities of Sage Therapeutics, Inc. are
listed, as required by law;
(2) to prepare and sign on my behalf any Form 144
pursuant to the Securities Act of 1933, as amended, and to file the
same with the Securities and Exchange Commission, NASDAQ, NYSE, and
each stock exchange on which shares of Common Stock or other
securities of Sage Therapeutics, Inc. are listed, as required by law;
(3) take any other action necessary or proper in
connection with the foregoing.
Unless earlier revoked under the next sentence,
this Power of
Attorney shall remain in effect as long as I am an executive officer
or director of Sage Therapeutics, Inc., and shall not be affected by
my subsequent disability or incompetence. I may revoke this Power of
Attorney by written notice delivered, in person or by nationally
recognized courier, to the attention of the SVP, General Counsel of
Sage Therapeutics, Inc.
/s/ George Golumbeski
(Signature of Executive Officer or Director)
Name: George Golumbeski
Date: January 22, 2019