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
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1. Name and Address of Reporting Person*
LALANDE KEVIN M.

(Last) (First) (Middle)
C/O SANTE VENTURES
300 W 6TH STREET, SUITE 2300

(Street)
AUSTIN TX 78701

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/01/2017
3. Issuer Name and Ticker or Trading Symbol
Molecular Templates, Inc. [ MTEM ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
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 7,897,298 I Held by Sante Health Ventures I, L.P.(1)
Common Stock 864,665 I Held by Sante Health Ventures I Annex Fund, L.P.(1)
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
Warrants 08/01/2017 08/01/2024 Common Stock 19,310 $6.8423 I(1) Held by Sante Health Ventures I, L.P.(1)
Warrants 08/01/2017 08/01/2024 Common Stock 4,827 $6.8423 I(1) Held by Sante Health Ventures I Annex Fund, L.P.(1)
Explanation of Responses:
1. The securities held by Sante Health Ventures I, L.P. and Sante Health Ventures I Annex Fund, L.P. may be deemed to be beneficially owned by the Reporting Person, who is a managing director of SHV Management Services, LLC, which is the general partner of SHV Management Services, LP, which is the general partner of Sante Health Ventures I, L.P., and SHV Annex Services, LP, which is the general partner of Sante Health Ventures I Annex Fund, L.P. As a managing director of SHV Management Services, LLC, the Reporting Person may be deemed to share voting and investment power over these securities held by Sante Health Ventures I, L.P. and Sante Health Ventures I Annex Fund, L.P. The Reporting Person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
Remarks:
Exhibit 24.1 - Power of Attorney
/s/ Jason Kim, attorney-in-fact 08/11/2017
** 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.