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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 06/18/2020 |
3. Issuer Name and Ticker or Trading Symbol
Repare Therapeutics Inc. [ RPTX ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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 Shares | 651,462 | I | See Footnote(1) |
Common Shares | 49,580 | I | See Footnote(2) |
Common Shares | 21,692 | I | See Footnote(3) |
Common Shares | 19,596 | I | See Footnote(4) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 | ||||
Class A Preferred Shares | (5) | (5) | Common Shares | 2,054,198 | (5) | I | See Footnote(1) |
Class A Preferred Shares | (5) | (5) | Common Shares | 156,335 | (5) | I | See Footnote(2) |
Class A Preferred Shares | (5) | (5) | Common Shares | 68,398 | (5) | I | See Footnote(3) |
Class A Preferred Shares | (5) | (5) | Common Shares | 61,791 | (5) | I | See Footnote(4) |
Class A Preferred Shares | (5) | (5) | Common Shares | 2,443,883 | (5) | I | See Footnote(6) |
Class B Preferred Shares | (5) | (5) | Common Shares | 111,361 | (5) | I | See Footnote(1) |
Class B Preferred Shares | (5) | (5) | Common Shares | 8,475 | (5) | I | See Footnote(2) |
Class B Preferred Shares | (5) | (5) | Common Shares | 3,708 | (5) | I | See Footnote(3) |
Class B Preferred Shares | (5) | (5) | Common Shares | 3,350 | (5) | I | See Footnote(4) |
Class B Preferred Shares | (5) | (5) | Common Shares | 875,568 | (5) | I | See Footnote(6) |
Class B Preferred Shares | (5) | (5) | Common Shares | 458,282 | (5) | I | See Footnote(7) |
Explanation of Responses: |
1. The securities are held by Versant Venture Capital V, L.P. ("VVC V"). The Reporting Person is a managing member of the general partner of VVC V, but disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein, if any. |
2. The securities are held by Versant Venture Capital V (Canada) LP ("VVC V (Canada)"). The Reporting Person is a director of the ultimate general partner of VVC V (Canada), but disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein, if any. |
3. The securities are held by Versant Ophthalmic Affiliates Fund I, L.P. ("VOAF I"). The Reporting Person is a managing member of the general partner of VOAF I, but disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein, if any. |
4. The securities are held by Versant Affiliates Fund V, L.P. ("VAF V"). The Reporting Person is a managing member of the general partner of VAF V, but disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein, if any. |
5. Each Class A Preferred Share and Class B Preferred Share is convertible at any time, at the holder's election, into Common Shares, on a one-for-one basis, has no expiration date and will convert into Common Shares upon the closing of the Issuer's initial public offering. |
6. The securities are held by Versant Venture Capital VI, L.P. ("VVC VI"). The Reporting Person is a managing member of the ultimate general partner of VVC VI, but disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein, if any. |
7. The securities are held by Versant Vantage I, L.P. ("VV I"). The Reporting Person is a managing member of the ultimate general partner of VV I, but disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein, if any. |
Remarks: |
/s/ Steve Forte, Attorney-in-Fact | 06/18/2020 | |
** 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 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. |