0001209191-22-049199.txt : 20220908
0001209191-22-049199.hdr.sgml : 20220908
20220908170448
ACCESSION NUMBER: 0001209191-22-049199
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20220902
FILED AS OF DATE: 20220908
DATE AS OF CHANGE: 20220908
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Pepe Jeffrey C.
CENTRAL INDEX KEY: 0001943992
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39756
FILM NUMBER: 221234403
MAIL ADDRESS:
STREET 1: C/O SILVERBACK THERAPEUTICS, INC.
STREET 2: 500 FAIRVIEW AVENUE N, SUITE 600
CITY: SEATTLE
STATE: WA
ZIP: 98109
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
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2022-09-02
0
0001671858
Silverback Therapeutics, Inc.
SBTX
0001943992
Pepe Jeffrey C.
C/O SILVERBACK THERAPEUTICS, INC.
500 FAIRVIEW AVENUE N, SUITE 600
SEATTLE
WA
98109
0
1
0
0
Interim CEO and GC
Common Stock
52323
D
Stock option (right to buy)
1.68
2029-09-10
Common Stock
35407
D
Stock option (right to buy)
1.27
2030-04-28
Common Stock
22401
D
Stock option (right to buy)
1.27
2030-04-28
Common Stock
17619
D
Stock option (right to buy)
1.27
2030-04-28
Common Stock
18268
D
Stock option (right to buy)
6.65
2030-09-30
Common Stock
26932
D
Stock option (right to buy)
21.00
2030-12-02
Common Stock
102039
D
Stock option (right to buy)
4.85
2032-01-31
Common Stock
45000
D
Stock option (right to buy)
4.85
2032-01-31
Common Stock
28500
D
Stock option (right to buy)
3.15
2032-05-01
Common Stock
79261
D
25% of the shares subject to the option vested on August 19, 2020, and the remaining shares will vest monthly thereafter over three years.
25% of the shares subject to the option vested on March 4, 2021, and the remaining shares will vest monthly thereafter over three years.
25% of the shares subject to the option vested on July 1, 2021, and the remaining shares will vest monthly thereafter over three years.
The shares subject to the option will vest in equal monthly installments over the 48 months beginning on October 18, 2020.
The shares subject to the option will vest in equal monthly installments over the 48 months beginning on October 22, 2020.
The shares subject to the option will vest in equal monthly installments over the 48 months beginning on January 3, 2021.
The shares subject to the option will vest in equal monthly installments over the 48 months beginning on March 1, 2022.
25% of the shares subject to the option will vest on February 1, 2023, and the remaining shares will vest monthly thereafter over three years.
The shares subject to the option will vest on May 2, 2023.
/s/ Jeffrey C. Pepe
2022-09-07
EX-24
2
poa.txt
POA DOCUMENT
LIMITED POWER OF ATTORNEY
FOR SECTION 16(a) FILINGS
Know all by these presents, that the undersigned hereby constitutes and appoints
each of Andrew Alwood and Jonathan Piazza, signing individually, as the
undersigned's true and lawful attorney-in fact to:
(1) Execute for and on behalf of the undersigned, in the undersigned's capacity
as an officer, director and/or stockholder of Silverback Therapeutics, Inc. (the
"Company"), Forms 3, 4, and 5 and amendments thereto in accordance with Section
16(a) of the Securities Exchange Act of 1934, as amended (the "Exchange Act")
and the rules thereunder;
(2) Do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable to complete and execute any such Form 3, 4, or 5,
or amendment thereto and timely file such form with the United States Securities
and Exchange Commission (the "SEC") and any stock exchange or similar authority;
and
(3) Take any other action of any type whatsoever which, in the opinion of any
such attorney-in-fact, may be necessary or desirable in connection with the
foregoing authority, it being understood that the documents executed by such
attorney-in-fact on behalf of the undersigned pursuant to this Limited Power of
Attorney shall be in such form and shall contain such terms and conditions as
such attorney-in-fact may approve in such attorney-in-facts discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever required,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be
done by virtue of this Limited Power of Attorney and the rights and powers
herein granted. The undersigned acknowledges that each of the foregoing
attorneys-in-fact, in serving in such capacity at the request of the
undersigned, is not assuming, nor is the Company assuming, any of the
undersigned's responsibilities to comply with Section 16 of the Exchange Act.
This Limited Power of Attorney shall remain in full force and effect until the
earlier to occur of (a) undersigned is no longer required to file Forms 3, 4 and
5 with respect to any securities issued by the Company, (b) revocation by the
undersigned in a signed writing delivered to the foregoing attorney-in-fact and
(c) as to any attorney in fact individually until such attorney-in-fact is no
longer employed by the Company. This Limited Power of Attorney may be filed
with the SEC as a confirming statement of the authority granted herein.
IN WITNESS WHEREOF, the undersigned has caused this Limited Power of Attorney to
be executed as of August 22, 2022.
/s/ Jeffrey C. Pepe, Ph.D., J.D.