Registration Form • Oct 16, 2018
Registration Form
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| OMB Number: | 3235-0076 | |
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| Estimated average burden hours per response |
4.00 | |
| 1. Issuer's Identity | |||||||
|---|---|---|---|---|---|---|---|
| CIK (Filer ID Number) | Previous Names | X None | Entity Type | ||||
| 0001119774 | X Corporation | ||||||
| Name of Issuer | Limited Partnership | ||||||
| COMPUGEN LTD | Limited Liability Company | ||||||
| Jurisdiction of Incorporation/Organization | |||||||
| General Partnership ISRAEL |
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| Business Trust Year of Incorporation/Organization |
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| Other (Specify) X Over Five Years Ago |
|||||||
| Within Last Five Years (Specify Year) | |||||||
| Yet to Be Formed | |||||||
| 2. Principal Place of Business and Contact Information | |||||||
| Name of Issuer | |||||||
| COMPUGEN LTD | |||||||
| Street Address 1 | Street Address 2 | ||||||
| 26 HAROKMIM STREET | BUILDING D | ||||||
| City | State/Province/Country | ZIP/PostalCode | Phone Number of Issuer | ||||
| HOLON | ISRAEL | 5885849 | 011-972-3-765-8585 | ||||
| 3. Related Persons | |||||||
| Last Name | First Name | Middle Name | |||||
| Cohen-Dayag | Anat | ||||||
| Street Address 1 | Street Address 2 | ||||||
| c/o Compugen Ltd. | 26 Harokmim Street | ||||||
| City | State/Province/Country | ZIP/PostalCode | |||||
| Holon Relationship: |
X Executive Officer |
ISRAEL X |
Director | Promoter | 5885849 | ||
| Clarification of Response (if Necessary): | |||||||
| Last Name | First Name | Middle Name | |||||
| Sekhri | Paul | ||||||
| Street Address 1 c/o Compugen Ltd. |
Street Address 2 26 Harokmim Street |
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| City | State/Province/Country | ZIP/PostalCode | |||||
| Holon | ISRAEL | 5885849 | |||||
| Relationship: | Executive Officer | X | Director | Promoter | |||
| Clarification of Response (if Necessary): | |||||||
| Last Name | First Name | Middle Name | |||||
| Aharonowitz | Yair | ||||||
| Street Address 1 | Street Address 2 | ||||||
| c/o Compugen Ltd. | 26 Harokmim Street | ||||||
| City Holon |
State/Province/Country ISRAEL |
ZIP/PostalCode 5885849 |
|||||
| Relationship: | Executive Officer | X Director |
Promoter | ||
|---|---|---|---|---|---|
| Clarification of Response (if Necessary): | |||||
| Last Name Bizzari Street Address 1 c/o Compugen Ltd. City Holon Relationship: |
Executive Officer Clarification of Response (if Necessary): |
First Name Jean-Pierre Street Address 2 ISRAEL |
26 Harokmim Street State/Province/Country X Director |
Promoter | Middle Name ZIP/PostalCode 5885849 |
| Last Name Halevy Street Address 1 c/o Compugen Ltd. City Holon Relationship: |
Executive Officer | First Name Gilead Street Address 2 ISRAEL |
26 Harokmim Street State/Province/Country X Director |
Promoter | Middle Name ZIP/PostalCode 5885849 |
| Clarification of Response (if Necessary): | |||||
| Last Name Savitzky Street Address 1 c/o Compugen Ltd. City Holon Relationship: |
Executive Officer | First Name Kinneret Street Address 2 ISRAEL |
26 Harokmim Street State/Province/Country X Director |
Promoter | Middle Name Livnat ZIP/PostalCode 5885849 |
| Clarification of Response (if Necessary): | |||||
| Last Name Ovadia Street Address 1 c/o Compugen Ltd. City Holon Relationship: |
Executive Officer | First Name Arie Street Address 2 ISRAEL |
26 Harokmim Street State/Province/Country X Director |
Promoter | Middle Name ZIP/PostalCode 5885849 |
| Clarification of Response (if Necessary): | |||||
| Last Name Zweifach Street Address 1 c/o Compugen Ltd. |
First Name Sanford Street Address 2 |
26 Harokmim Street | Middle Name | ||
| City Holon Relationship: |
Executive Officer | ISRAEL | State/Province/Country X Director |
Promoter | ZIP/PostalCode 5885849 |
Clarification of Response (if Necessary):
| Last Name | First Name | Middle Name | |
|---|---|---|---|
| Krashin | Ari | ||
| Street Address 1 | Street Address 2 | ||
| c/o Compugen Ltd. | 26 Harokmim Street | ||
| City | State/Province/Country | ZIP/PostalCode | |
| Holon | ISRAEL | 5885849 | |
| Relationship: | Executive Officer Director X |
Promoter | |
| Clarification of Response (if Necessary): | |||
| Last Name | First Name | Middle Name | |
| Christoffersen | Kirk | A. | |
| Street Address 1 | Street Address 2 | ||
| c/o Compugen Ltd. | 26 Harokmim Street | ||
| City | State/Province/Country | ZIP/PostalCode | |
| Holon | ISRAEL | 5885849 | |
| Relationship: | X Executive Officer Director |
Promoter | |
| Clarification of Response (if Necessary): | |||
| Last Name | First Name | Middle Name | |
| Adewoye | Henry | ||
| Street Address 1 | Street Address 2 | ||
| c/o Compugen Ltd. | 26 Harokmim Street | ||
| City | State/Province/Country | ZIP/PostalCode | |
| Holon | ISRAEL | 5885849 | |
| Relationship: | X Executive Officer Director |
Promoter | |
| Clarification of Response (if Necessary): | |||
| Last Name | First Name | Middle Name | |
| Hunter | John | ||
| Street Address 1 | Street Address 2 | ||
| c/o Compugen Ltd. | 26 Harokmim Street | ||
| City | State/Province/Country | ZIP/PostalCode | |
| Holon | ISRAEL | 5885849 | |
| Relationship: | X Executive Officer Director |
Promoter | |
| Clarification of Response (if Necessary): | |||
| Last Name | First Name | Middle Name | |
| Levine | Zurit | ||
| Street Address 1 | Street Address 2 | ||
| c/o Compugen Ltd. | 26 Harokmim Street | ||
| City | State/Province/Country | ZIP/PostalCode | |
| Holon | ISRAEL | 5885849 | |
| Relationship: | X Executive Officer Director |
Promoter | |
| Clarification of Response (if Necessary): | |||
| Agriculture | Health Care | Retailing |
|---|---|---|
| Banking & Financial Services | Biotechnology | Restaurants |
| Commercial Banking | Health Insurance | Technology Computers |
| Insurance Investing Investment Banking |
Hospitals & Physicians Pharmaceuticals Other Health Care |
Telecommunications Other Technology |
| Pooled Investment Fund | Manufacturing | Travel |
| Is the issuer registered as an investment company under the Investment Company Act of 1940? Yes No Other Banking & Financial Services Business Services |
Real Estate Commercial Construction REITS & Finance Residential Other Real Estate |
Airlines & Airports Lodging & Conventions Tourism & Travel Services Other Travel X Other |
| Energy | ||
| Coal Mining | ||
| Electric Utilities | ||
| Energy Conservation Environmental Services |
||
| Oil & Gas | ||
| Other Energy |
| Revenue Range No Revenues |
OR | Aggregate Net Asset Value Range No Aggregate Net Asset Value |
|---|---|---|
| \$1 - \$1,000,000 | \$1 - \$5,000,000 | |
| \$1,000,001 - \$5,000,000 | \$5,000,001 - \$25,000,000 | |
| \$5,000,001 - \$25,000,000 | \$25,000,001 - \$50,000,000 | |
| \$25,000,001 - \$100,000,000 |
\$50,000,001 - \$100,000,000 | |
| Over \$100,000,000 | Over \$100,000,000 | |
| X Decline to Disclose | Decline to Disclose | |
| Not Applicable | Not Applicable |

| Section 3(c)(7) | |||
|---|---|---|---|
| 7. Type of Filing | |||
| X New Notice Date of First Sale 2018-10-11 Amendment |
First Sale Yet to Occur | ||
| 8. Duration of Offering | |||
| Does the Issuer intend this offering to last more than one year? | Yes X No |
||
| 9. Type(s) of Securities Offered (select all that apply) | |||
| X Equity Debt Option, Warrant or Other Right to Acquire Another Security Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security |
Pooled Investment Fund Interests Tenant-in-Common Securities Mineral Property Securities Other (describe) |
||
| 10. Business Combination Transaction | |||
| Is this offering being made in connection with a business combination transaction, such as a Yes X No merger, acquisition or exchange offer? Clarification of Response (if Necessary): |
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| 11. Minimum Investment | |||
| Minimum investment accepted from any outside investor \$ 0 USD 12. Sales Compensation |
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| Recipient | Recipient CRD Number X None |
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| (Associated) Broker or Dealer X None |
(Associated) Broker or Dealer CRD Number X None |
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| Street Address 1 | Street Address 2 | ||
| City State/Province/Country |
ZIP/Postal Code | ||
| State(s) of Solicitation All States Non-US/Foreign AL AK AZ AR CA CO CT IL IN IA KS KY LA ME MT NE NV NH NJ NM NY |
DE DC FL GA HI ID MD MA MI MN MS MO NC ND OH OK OR PA |
| RI SC SD |
TN TX |
UT | VT VA WA |
WV WI |
WY PR |
|---|---|---|---|---|---|
| 13. Offering and Sales Amounts | |||||
| Total Offering Amount | \$ 12,000,000 | USD | or Indefinite |
||
| Total Amount Sold | \$ 12,000,000 | USD | |||
| Total Remaining to be Sold | \$ 0 | USD or Indefinite |
|---|---|---|
| ---------------------------- | ------ | ------------------------- |
Clarification of Response (if Necessary):
Select if securities in the offering have been or may be sold to persons who do not qualify as accredited investors, and enter the number of such non-accredited investors who already have invested in the offering.
Regardless of whether securities in the offering have been or may be sold to persons who do not qualify as accredited investors, enter the total number of investors who already have invested in the offering: 1
Provide separately the amounts of sales commissions and finders fees expenses, if any. If the amount of an expenditure is not known, provide an estimate and check the box next to the amount.
| Sales Commissions | \$ 0 USD | Estimate |
|---|---|---|
| Finders' Fees | \$ 0 USD | Estimate |
Clarification of Response (if Necessary):
Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. If the amount is unknown, provide an estimate and check the box next to the amount.
\$ 0 USD Estimate
Clarification of Response (if Necessary):
Please verify the information you have entered and review the Terms of Submission below before signing and submitting this notice.
In submitting this notice, each identified issuer is:
1933, the Securities Exchange Act of 1934, the Trust Indenture Act of 1939, the Investment Company Act of 1940, or the Investment Advisers Act of 1940, or any rule or regulation under any of these statutes; or (ii) the laws of the State in which the issuer maintains its principal place of business or any State in which this notice is filed.
• Certifying that, if the issuer is claiming a Regulation D exemption for the offering, the issuer is not disqualified from relying on Regulation D for one of the reasons stated in Rule 505(b)(2)(iii) or Rule 506(d).
Each Issuer identified above has read this notice, knows the contents to be true, and has duly caused this notice to be signed on its behalf by the undersigned duly authorized person.
For signature, type in the signer's name or other letters or characters adopted or authorized as the signer's signature.
| Issuer | Signature | Name of Signer |
Title | Date |
|---|---|---|---|---|
| COMPUGEN LTD | /s/ Dr. Anat Cohen-Dayag |
Dr. Anat Cohen-Dayag |
CEO and President | 2018-10-16 |
* This undertaking does not affect any limits Section 102(a) of the National Securities Markets Improvement Act of 1996 ("NSMIA") [Pub. L. No. 104-290, 110 Stat. 3416 (Oct. 11, 1996)] imposes on the ability of States to require information. As a result, if the securities that are the subject of this Form D are "covered securities" for purposes of NSMIA, whether in all instances or due to the nature of the offering that is the subject of this Form D, States cannot routinely require offering materials under this undertaking or otherwise and can require offering materials only to the extent NSMIA permits them to do so under NSMIA's preservation of their anti-fraud authority.
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