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) 10/01/2020 |
3. Issuer Name and Ticker or Trading Symbol
C4 Therapeutics, Inc. [ CCCC ] |
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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 Stock | 132,875 | I | See Footnote(1) |
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 | ||||
Series Seed Preferred Stock | (2) | (2) | Common Stock | 237,149 | (2) | I | See Footnote(1) |
Series A Preferred Stock | (2) | (2) | Common Stock | 1,482,183 | (2) | I | See Footnote(1) |
Series B Preferred Stock | (2) | (2) | Common Stock | 2,484,425 | (2) | I | By Cobro Ventures Opportunity Fund, L.P.(3) |
Stock Option (Right to Buy) | (4) | 07/12/2026 | Common Stock | 3,745 | $2.11 | D |
Explanation of Responses: |
1. Shares held by Reporting Person as trustee of the Marc Andrew Cohen Revocable Trust. The Reporting Person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
2. Each share of Series Seed Preferred Stock, Series A Preferred Stock, and Series B Preferred Stock is convertible into Common Stock on a 8.4335-to-one basis into the number of shares of Common Stock shown in Column 3 at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering without payment or further consideration. The shares have no expiration date. |
3. Shares held by Cobro Ventures Opportunity Fund, L.P. ("Cobro Ventures"). The Reporting Person serves as a manager of Cobro Opportunity Fund GP, LLC, the general partner of Cobro Ventures, and may be deemed to exercise voting and investment power over the shares held by Cobro Ventures. The Reporting Person disclaims beneficial ownership of the shares held by Cobro Ventures except to the extent of his pecuniary interest therein. |
4. Represents underlying unexercised stock options that were granted on July 13, 2016. The terms of the original grant provide that 12.5% of this option vested and became exercisable on December 31, 2016, with the remainder vesting in 28 equal quarterly installments thereafter, subject to the Reporting Person's continuous service through each such date. |
Remarks: |
Exhibit 24 - Power of Attorney |
/s/ Jolie M. Siegel, Attorney-in-Fact | 10/01/2020 | |
** 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. |