0000899243-20-027862.txt : 20201008 0000899243-20-027862.hdr.sgml : 20201008 20201008194354 ACCESSION NUMBER: 0000899243-20-027862 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20201008 FILED AS OF DATE: 20201008 DATE AS OF CHANGE: 20201008 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Brous Tyler CENTRAL INDEX KEY: 0001827387 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39593 FILM NUMBER: 201231865 MAIL ADDRESS: STREET 1: 1018 W 11TH ST., SUITE 100 CITY: AUSTIN STATE: TX ZIP: 78703 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Shattuck Labs, Inc. CENTRAL INDEX KEY: 0001680367 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 812575858 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1018 W. 11TH STREET CITY: AUSTIN STATE: TX ZIP: 78703 BUSINESS PHONE: 919-864-2700 MAIL ADDRESS: STREET 1: 1018 W. 11TH STREET CITY: AUSTIN STATE: TX ZIP: 78703 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2020-10-08 0 0001680367 Shattuck Labs, Inc. STTK 0001827387 Brous Tyler C/O SHATTUCK LABS, INC. 1018 W. 11TH STREET, SUITE 100 AUSTIN TX 78703 1 0 0 0 Common Stock 30825 D Common Stock 52745 I See Footnote Series A Preferred Stock Common Stock 629432 I See Footnote Series A Preferred Stock Common Stock 16440 I See Footnote Series B Preferred Stock Common Stock 27235 I See Footnote Series B-1 Preferred Stock Common Stock 87132 I See Footnote Stock Option (Right to Buy) 15.00 2030-09-24 Common Stock 27400 D These shares are held directly by Lennox Dallas Partners, LP ("Lennox Partners"). The Reporting Person is the vice president of RS Holdings, Inc., the general partner of Lennox Partners. The Reporting Person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except the extent of his pecuniary interest therein. Each share of Series A Preferred Stock is convertible into 6.85 shares of common stock at any time at the holder's election and will convert automatically immediately prior to the closing of the Issuer's initial public offering (the "IPO"). The Series A Preferred Stock has no expiration date. These shares are held directly by Lennox Dallas Holdings, LLC - Series 3. The Reporting Person is the Manager of Lennox Dallas Holdings, LLC - Series 3. The Reporting Person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except the extent of his pecuniary interest therein. Each share of Series B Preferred Stock is convertible into 6.85 shares of common stock at any time at the holder's election and will convert automatically immediately prior to the closing of the IPO. The Series B Preferred Stock has no expiration date. These shares are held directly by Lennox Dallas Holdings, LLC - Series 9. The Reporting Person is the Manager of Lennox Dallas Holdings, LLC - Series 9. The Reporting Person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except the extent of his pecuniary interest therein. Each share of Series B-1 Preferred Stock is convertible into 6.85 shares of common stock at any time at the holder's election and will convert automatically immediately prior to the closing of the IPO. The Series B-1 Preferred Stock has no expiration date. These shares are held directly by Lennox Dallas Holdings, LLC - Series 10. The Reporting Person is the Manager of Lennox Dallas Holdings, LLC - Series 10. The Reporting Person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except the extent of his pecuniary interest therein. This option represents a right to purchase a total of 27,400 shares of the Issuer's common stock and will vest in in equal monthly installments from October 25, 2020 to September 25, 2021, subject to the Reporting Person's continued service to the Issuer. Exhibit 24 - Power of Attorney /s/ Erin Ator Thomson, Attorney-in-fact for Tyler Brous 2020-10-08 EX-24 2 attachment1.htm EX-24 DOCUMENT

                               POWER OF ATTORNEY

        Know all by these presents that the undersigned hereby constitutes and
appoints each of Andrew R. Neill, Taylor Schreiber and Erin Ator Thomson, and
any of their substitutes, signing singly, as the undersigned's true and lawful
attorney-in-fact to:

1.  prepare, execute in the undersigned's name and on the undersigned's behalf,
    and submit to the U.S. Securities and Exchange Commission (the "SEC") a Form
    ID, including amendments thereto, and any other document necessary or
    appropriate to obtain codes, passwords, and passphrases enabling the
    undersigned to make electronic filings with the SEC of reports require by
    the Securities Exchange Act of 1934 or any rule or regulation of the SEC;

2.  execute for and on behalf of the undersigned, in the undersigned's capacity
    as a director and/or officer of Shattuck Labs, Inc. (the "Company"), Forms
    3, 4, and 5 in accordance with Section 16(a) of the Securities Exchange Act
    of 1934 and the rules thereunder;

3.  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, complete and execute any amendment or amendments thereto, and timely file
    such form with the SEC and any securities exchange or similar authority; and

4.  take any other action of any type whatsoever in connection with the
    foregoing which, in the opinion of such attorney-in-fact, may be of benefit
    to, in the best interest of, or legally required by, the undersigned, it
    being understood that the documents executed by such attorney-in-fact on
    behalf of the undersigned pursuant to this 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-fact's 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
requisite, 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 each 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 power of attorney and the
rights and powers herein granted.  The undersigned also ratifies hereby any
action previously taken by each attorney-in-fact that would have been authorized
by this power of attorney if it has been in effect at the time such action was
taken.  The undersigned acknowledges that each attorney-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 Securities Exchange Act of 1934, as amended.

        This Power of Attorney shall remain in full force and effect until the
earliest to occur of (a) undersigned is no longer required to file Forms 3, 4,
and 5 with respect to the undersigned's holdings of and transactions in
securities issued by the Company, (b) revocation by the undersigned in a signed
writing delivered to the foregoing attorneys-in-fact or (c) as to any attorney-
in-fact individually, until such attorney-in-fact is no longer employed by the
Company or its subsidiaries.

IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of 09/29/2020.

                                        /s/ Tyler Brous
                                        ---------------------------
                                        Tyler Brous