0001209191-20-062055.txt : 20201207 0001209191-20-062055.hdr.sgml : 20201207 20201207200236 ACCESSION NUMBER: 0001209191-20-062055 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201203 FILED AS OF DATE: 20201207 DATE AS OF CHANGE: 20201207 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Thompson Peter A. CENTRAL INDEX KEY: 0001357522 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39756 FILM NUMBER: 201374133 MAIL ADDRESS: STREET 1: C/O ANTHERA PHARMACEUTICALS, INC. STREET 2: 25801 INDUSTRIAL BOULEVARD, SUITE B CITY: HAYWARD STATE: CA ZIP: 94545 FORMER NAME: FORMER CONFORMED NAME: Thompson Peter A DATE OF NAME CHANGE: 20060327 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Silverback Therapeutics, Inc. CENTRAL INDEX KEY: 0001671858 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 811489190 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 500 FAIRVIEW AVENUE NORTH, SUITE 600 CITY: SEATTLE STATE: WA ZIP: 98109 BUSINESS PHONE: 206-456-2900 MAIL ADDRESS: STREET 1: 500 FAIRVIEW AVENUE NORTH, SUITE 600 CITY: SEATTLE STATE: WA ZIP: 98109 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2020-12-03 0 0001671858 Silverback Therapeutics, Inc. SBTX 0001357522 Thompson Peter A. C/O SILVERBACK THERAPEUTICS, INC. 500 FAIRVIEW AVENUE N, SUITE 600 SEATTLE WA 98109 1 0 1 0 Stock Option (right to buy) 21.00 2020-12-03 4 A 0 38270 0.00 A 2030-12-02 Common Stock 38270 38270 D The shares subject to the option vest in equal monthly installments over the 36 months following December 3, 2020. The Reporting Person is the designated representative of OrbiMed Advisors LLC ("OrbiMed Advisors") on the Issuer's Board of Directors. The reportable securities are owned indirectly by OrbiMed Private Investments VI, LP ("OPI VI"). OrbiMed Capital GP VI LLC ("GP VI") is the general partner of OPI VI and OrbiMed Advisors is the managing member of GP VI. The Reporting Person disclaims beneficial ownership of the securities reported herein for the purposes of Rule 16a-1(a) under the Securities Exchange Act of 1934, as amended (the "Exchange Act"), except to the extent of his pecuniary interest therein, if any. /s/ Jeffrey C. Pepe, Attorney-in-Fact 2020-12-03