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 BLUEBIRD BIO, INC.|
|60 BINNEY STREET|
2. Date of Event Requiring Statement
3. Issuer Name and Ticker or Trading Symbol
bluebird bio, Inc.
[ BLUE ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
Chief Commercial Officer, SGD
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/ Helen C. Fu, Attorney-in-Fact
||** 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.|
LIMITED POWER OF ATTORNEY
The undersigned hereby constitutes and appoints each of William D.
Baird, III, Jason F. Cole and Helen Fu, 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 bluebird bio, Inc., 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
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 May 10, 2021.
/s/ Thomas Klima