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*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Silverback Therapeutics, Inc. [ SBTX ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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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)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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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) | |||||||||||||||
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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*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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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). | ||
** 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. |