SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Presidio Management Group XII, L.L.C.

(Last) (First) (Middle)
1460 EL CAMINO REAL, SUITE100

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Silverback Therapeutics, Inc. [ SBTX ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
12/08/2020
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 12/08/2020 C 1,779,969 A (2) 1,779,969 I By U.S. Venture Partners XII, L.P.(3)
Common Stock 12/08/2020 C 289,198 A (2) 2,069,167 I By U.S. Venture Partners XII, L.P.(3)
Common Stock 12/08/2020 C 90,335 A (2) 90,335 I By U.S. Venture Partners XII-A, L.P.(3)
Common Stock 12/08/2020 C 14,677 A (2) 105,012 I By U.S. Venture Partners XII-A, L.P.(3)
Common Stock 12/08/2020 P(1) 47,619 A $21 47,619 I Directly owned by Tansey
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Preferred Series B Stock (2) 12/08/2020 C 6,609,027 (2) (2) Common Stock 1,779,969 $0(2) 0 I By U.S. Venture Partners XII, L.P.(3)
Preferred Series B Stock (2) 12/08/2020 C 335,417 (2) (2) Common Stock 90,335 $0(2) 0 I By U.S. Venture Partners XII-A, L.P.(3)
Preferred Series C Stock (2) 12/08/2020 C 1,073,793 (2) (2) Common Stock 289,198 $0(2) 0 I By U.S. Venture Partners XII, L.P.(3)
Preferred Series C Stock (2) 12/08/2020 C 54,496 (2) (2) Common Stock 14,677 $0(2) 0 I By U.S. Venture Partners XII-A, L.P.(3)
1. Name and Address of Reporting Person*
Presidio Management Group XII, L.L.C.

(Last) (First) (Middle)
1460 EL CAMINO REAL, SUITE100

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
U.S. Venture Partners XII, L.P.

(Last) (First) (Middle)
1460 EL CAMINO REAL, SUITE 100

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
U.S. Venture Partners XII-A, L.P.

(Last) (First) (Middle)
1460 EL CAMINO REAL, SUITE 100

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Tansey Casey M

(Last) (First) (Middle)
1460 EL CAMINO REAL, SUITE 100

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
Explanation of Responses:
1. The shares were purchased in the Issuer's initial public offering.
2. Series B and Series C Preferred Stock automatically converted into shares of the Issuer's Common Stock immediately upon the closing of the Issuer's imitial public offering, for no additional consideration at a rate of 1 share of Common Stock for each 3.713 shares of Preferred Stock, based on the conversion price currently in effect. The Preferred Stock had no expiration date.
3. Presidio Management Group XII, L.L.C. ("PMG XII"), the general partner of each of U.S. Venture Partners XII, L.P. and U.S. Venture Partners XII-A, L.P. (together, the "USVP XII Funds"), has sole voting and dispositive power with respect to the shares held by the USVP XII. Casey Tansey is the sole managing partner of PMG XII and may be deemed to have voting and dispositive power over the reported securities held by the USVP XII Funds, and each of the foregoing persons disclaims beneficial ownership of such securities, except to the extent of any pecuniary interest therein.
Dale Holladay, Attorney-in-Fact for each Reporting Person 12/08/2020
** 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 4 (b)(v).
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