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) 09/27/2017 |
3. Issuer Name and Ticker or Trading Symbol
Deciphera Pharmaceuticals, Inc. [ DCPH ] |
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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) |
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 | ||||
Stock Option (Right to Buy) | (1) | 10/20/2026 | Common Stock | 240,548(2) | $3.95 | D | |
Stock Option (Right to Buy) | (3) | 06/03/2027 | Common Stock | 20,283(2) | $6.13 | D | |
Stock Option (Right to Buy) | (4) | 09/26/2027 | Common Stock | 42,375 | $17 | D |
Explanation of Responses: |
1. This stock option award was issued pursuant to Deciphera Pharmaceuticals, LLC's 2015 Equity Incentive Plan. The option vests in 16 equal quarterly installments at the end of each quarter following the vesting commencement date of October 3, 2016, subject to continued service through such dates. |
2. These options are currently options to purchase shares of common stock of Deciphera Pharmaceuticals, LLC, a wholly-owned subsidiary of the Issuer, and will be exchanged for options of the Issuer on a 1 to 5.65 basis immediately prior to the closing of the initial public offering of the Issuer (the "Exchange") pursuant to that certain Reorganization Agreement and Plan of Merger by and among the Issuer, Deciphera Pharmaceuticals, LLC and the other parties named therein, dated September 26, 2017 (the "Merger Agreement"). The amount in this Column 3 reflects the options that will be outstanding following the Exchange. |
3. This stock option award was issued pursuant to Deciphera Pharmaceuticals, LLC's 2015 Equity Incentive Plan. The option vests in 48 equal monthly installments at the end of each month following the vesting commencement date of May 26, 2017, subject to continued service through such dates. |
4. This stock option was issued pursuant to the Issuer's 2017 Stock Option and Incentive Plan. The option vests in 48 equal monthly installments following the vesting commencement date of September 27, 2017, subject to continued service through such dates. |
Remarks: |
Power of Attorney - Exhibit 24 attached |
/s/ Jeffrey M. Held, Attorney-in-Fact | 09/20/2018 | |
** 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. |