0001209191-20-005447.txt : 20200129
0001209191-20-005447.hdr.sgml : 20200129
20200129201249
ACCESSION NUMBER: 0001209191-20-005447
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200129
FILED AS OF DATE: 20200129
DATE AS OF CHANGE: 20200129
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Makhzoumi Mohamad
CENTRAL INDEX KEY: 0001630226
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39200
FILM NUMBER: 20559545
MAIL ADDRESS:
STREET 1: 2855 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Black Diamond Therapeutics, Inc.
CENTRAL INDEX KEY: 0001701541
STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 139 MAIN STREET
CITY: CAMBRIDGE
STATE: MA
ZIP: 02142
BUSINESS PHONE: 617-417-5868
MAIL ADDRESS:
STREET 1: 139 MAIN STREET
CITY: CAMBRIDGE
STATE: MA
ZIP: 02142
FORMER COMPANY:
FORMER CONFORMED NAME: Aset Therapeutics, Inc.
DATE OF NAME CHANGE: 20170321
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2020-01-29
0
0001701541
Black Diamond Therapeutics, Inc.
BDTX
0001630226
Makhzoumi Mohamad
2855 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
Series B Preferred Stock
Common Stock
2176957
I
See footnote
Series C Preferred Stock
Common Stock
471800
I
See footnote
Each share of Series B Preferred Stock is convertible into shares of the Issuer's Common Stock on a one-for-3.01581 basis. Upon the closing of the Issuer's initial public offering, all shares of Series B Preferred Stock will convert into the number of shares of Common Stock of the Issuer shown in column 3. The Series B Preferred Stock has no expiration date.
The Reporting Person is a manager of NEA 16 GP, LLC, ("NEA 16 GP") which is the sole general partner of NEA Partners 16, L.P. ("NEA Partners 16"). NEA Partners 16 is the sole general partner of New Enterprise Associates 16, L.P. ("NEA 16"), which is the direct beneficial owner of the shares. The Reporting Person disclaims beneficial ownership within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise of such portion of the shares held by NEA 16 in which the Reporting Person has no pecuniary interest.
Each share of Series C Preferred Stock is convertible into shares of the Issuer's Common Stock on a one-for-3.01581 basis. Upon the closing of the Issuer's initial public offering, all shares of Series C Preferred Stock will convert into the number of shares of Common Stock of the Issuer shown in column 3. The Series C Preferred Stock has no expiration date.
/s/ Sasha Keough, attorney-in-fact
2020-01-29