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 |
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1. Name and Address of Reporting Person*
| C/O BLUEPRINT MEDICINES CORPORATION |
| 45 SIDNEY STREET |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
12/08/2021
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3. Issuer Name and Ticker or Trading Symbol
Blueprint Medicines Corp
[ BPMC ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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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)
| 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 |
|---|
| 1. Title of Security (Instr.
4)
|
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)
|
|---|
| 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 |
| Explanation of Responses: |
| Remarks: |
|
| No securities are beneficially owned. |
|
/s/ Ariel Hurley, Attorney-in-Fact |
12/10/2021 |
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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
The undersigned hereby constitutes and appoints each
of Tracey McCain, Ariel Hurley and Michael Landsittel,
and each of them individually, and with full power of
substitution, the undersigned's true and lawful
attorney-in-fact to:
(1) Complete and execute for and on behalf
of the undersigned, in the undersigned's capacity as
an officer, director and/or ten percent (10%)
shareholder of Blueprint Medicines Corporation, a
Delaware corporation (the "Company") any and all
instruments, certificates and documents required to be
executed on behalf of the undersigned as an individual
or on behalf of the undersigned's company or
partnership, as the case may be, pursuant to
Section 13 and Section 16 of the Securities Exchange
Act of 1934, as amended (the "Exchange Act") or the
rules and regulations thereunder;
(2) Do and perform any and all acts for and
on behalf of the undersigned which may be necessary or
desirable to complete and execute any such
instruments, certificates or documents required to be
filed pursuant to Sections 13 and 16 of the Exchange
Act or the rules or regulations thereunder and timely
file such forms with the United States Securities and
Exchange Commission and any stock exchange or similar
authority; and
(3) 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 any 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, acting singly, full power and
authority to do and perform any and every act which is
necessary, proper or desirable 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 any such attorney-
in-fact, or any 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 each of the
foregoing attorneys-in-fact, in serving in such
capacity at the request of the undersigned, are not
assuming, nor is the Company assuming, any of the
undersigned's responsibilities to comply with
Section 13 or Section 16 of the Exchange Act or the
rules or regulations thereunder. The undersigned
hereby agrees to indemnify each attorney-in-fact and
the Company from and against any demand, damage, loss,
cost or expense arising from any false or misleading
information provided by the undersigned to such
attorney-in fact.
This Power of Attorney shall remain in full force
and effect until the undersigned is no longer required
to file any instruments, certificates and documents
pursuant to Section 13 and 16 of the Exchange Act or
the rules or regulations thereunder 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 December
9th, 2021.
By:
/s/ Daniella Beckman
Name: Daniella Beckman
