View:
Download DOC
Download PDF
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*
ROBINS CHAD M
(Last) (First) (Middle)
C/O ADAPTIVE BIOTECHNOLOGIES CORPORATION
1551 EASTLAKE AVE E STE 200
(Street)
SEATTLE WA 98102
(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/26/2019 		3. Issuer Name and Ticker or Trading Symbol
Adaptive Biotechnologies Corp [ ADPT ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
CEO and Chairman
 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 1,787,500 D
Common Stock 2,237,500(1) I By South Dakota Trust Company, Trustee of the Harlan Robins 2017 Trust
Common Stock 500,000(1) I By HSR 2014 Mother's Trust U/T/A dated June 17, 2014
Common Stock 350,000(1) I By HSR 2017 Trust for Descendants, u/a/d November 10, 2017
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
Stock Option (Right to Buy) (2) 12/20/2021 Common Stock 800,000 0.33 D
Stock Option (Right to Buy) (2) 06/09/2025 Common Stock 800,000 6.32 D
Stock Option (Right to Buy) (3) 02/07/2028 Common Stock 600,000 6.55 D
Stock Option (Right to Buy) (4) 02/07/2029 Common Stock 410,000 7.27 D
Series E-1 Preferred Stock (5) (5) Common Stock 70,680 0.0(5) D
Explanation of Responses:
1. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
2. The option is fully vested and exercisable.
3. The options vested with respect to 1/4 of such shares on November 1, 2018, with 1/48 of such shares vesting thereafter at the end of each full month of continuous service until fully vested.
4. The options vest with respect to 1/4 of such shares on January 1, 2020, with 1/48 of such shares vesting thereafter at the end of each full month of continuous service until fully vested.
5. The shares of preferred stock will convert immediately upon the closing of an initial public offering of the Issuer's common stock on a one-for-one basis and have no expiration date.
/s/ Chad M Robins by Stacy Taylor, Attorney-in-Fact 06/26/2019
** 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.
crobins lpoa 
ADAPTIVE BIOTECHNOLOGIES CORPORATION

            LIMITED POWER OF ATTORNEY
           FOR SECTION 16(a) REPORTING

	KNOW ALL PERSONS BY THESE PRESENTS, that the undersigned hereby
revokes any prior power of attorney regarding reporting requirements
under Section 16(a) of the Securities Exchange Act of 1934, as amended
(the "Exchange Act") with respect to equity securities of the Company, and
hereby makes, constitutes and appoints Chad Cohen, Stacy Taylor and
Kyle Piskel and each of them, as the undersigned's true and lawful
attorney-in-fact (the "Attorney-in-Fact"), with full power of substitution
and resubstitution, each with the power to act alone for the undersigned
and in the undersigned's name, place and stead, in any and all
capacities to:

	1.	Prepare, execute, deliver and file with the United
States Securities and Exchange Commission, any national securities
exchange and Adaptive Biotechnologies Corporation (the "Company") any and
all reports (including any amendment thereto) of the undersigned
required or considered advisable under Section 16(a) of the Exchange Act,
and the rules and regulations thereunder, with respect to the equity
securities of the Company, including Form 3 (Initial Statement of
Beneficial Ownership of Securities), Form 4 (Statement of Changes in
Beneficial Ownership), and Form 5 (Annual Statement of Changes in
Beneficial Ownership); and

	2.	Seek or obtain, as the undersigned's representative and
on the undersigned's behalf, information on transactions in the Company's
equity securities from any third party, including the Company, brokers,
dealers, employee benefit plan administrators and trustees, and the
undersigned hereby authorizes any such third party to release any such
information to the Attorney-in-Fact.

	The undersigned acknowledges that:

	1.	This Limited Power of Attorney authorizes, but does not
require, the Attorney-in-Fact to act at his or her discretion on
information provided to such Attorney-in-Fact without independent
verification of such information;

	2.	Any documents prepared and/or executed by the
Attorney-in-Fact on behalf of the undersigned pursuant to this
Limited Power of Attorney will be in such form and will contain such
information as the Attorney-in-Fact, in his or her discretion, deems
necessary or desirable;

	3.	Neither the Company nor the Attorney-in-Fact assumes any
liability for the undersigned's responsibility to comply with the
requirements of Section 16 of the Exchange Act, any liability of the
undersigned for any failure to comply with such requirements, or any
liability of the undersigned for disgorgement of profits under
Section 16(b) of the Exchange Act; and

	4.	This Limited Power of Attorney does not relieve the
undersigned from responsibility for compliance with the undersigned's
obligations under Section 16 of the Exchange Act, including, without,
limitation, the reporting requirements under Section 16(a) of the
Exchange Act.

	The undersigned hereby grants to the Attorney-in-Fact full power
and authority to do and perform each and every act and thing requisite,
necessary or convenient to be done in connection with the foregoing,
as fully, to all intents and purposes, as the undersigned might or
could do in person, hereby ratifying and confirming all that the
Attorney-in-Fact, or his or her substitute or substitutes, shall
lawfully do or cause to be done by authority of this Limited Power
of Attorney.

	This Limited Power of Attorney shall remain in full force and
effect until the undersigned is no longer required to file Forms 3, 4
or 5 with respect to the undersigned's holdings of and transactions in
equity securities of the Company, and shall only be revoked upon the
earliest of (i) revocation by the undersigned in a signed writing
delivered to the Attorney-in-Fact or to the Secretary of the Company,
(ii) termination of the undersigned's service as an employee or director
(as applicable) of the Company, (iii) termination of the Attorney-in-Fact's
service as an officer or other employee of the Company, or (iv) execution
of a subsequent power of attorney by the undersigned which specifically
provides for the revocation of any prior power of attorney regarding
reporting requirements under Section 16(a) of the Exchange Act.

	This Limited Power of Attorney shall be governed and construed
in accordance the laws of the State of Delaware without regard to
the laws that might otherwise govern under applicable principles of
conflicts of laws thereof.

	IN WITNESS WHEREOF, the undersigned has caused this Limited Power
of Attorney to be executed as of June 21, 2019.

	Signature:	/s/ Chad M Robins