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*
Vellanki Avanish

(Last) (First) (Middle)
C/O RAIN THERAPEUTICS INC.
8000 JARVIS AVENUE, SUITE 204

(Street)
NEWARK CA 94560

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
04/22/2021
3. Issuer Name and Ticker or Trading Symbol
Rain Therapeutics Inc. [ RAIN ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President and CEO
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 2,361,329 D
Common Stock 138,901 I By Trust
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
Series A Preferred Stock (1) (1) Common Stock 11,212(1) (1) D
Stock Option (Right to Buy) (2) 11/12/2025 Common Stock 46,300 $4 D
Explanation of Responses:
1. Each share of Series A Preferred Stock is convertible into common stock on a one-for-1.0799 basis into the number of shares of common stock shown in column 3 at any time at the holder's election and will convert automatically upon the closing of the Issuer's initial public offering. The Series A Preferred Stock has no expiration date.
2. This option represents a right to purchase a total of 46,300 shares of the Issuer's common stock, which vests in equal monthly installments through November 13, 2024, subject to the Reporting Person's continued service to the Issuer.
Remarks:
Exhibit 24 - Power of Attorney
/s/ Nelson Cabatuan, Attorney-in-fact for Avanish Vellanki 04/22/2021
** 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.