0001209191-21-049376.txt : 20210803
0001209191-21-049376.hdr.sgml : 20210803
20210803165506
ACCESSION NUMBER: 0001209191-21-049376
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210803
FILED AS OF DATE: 20210803
DATE AS OF CHANGE: 20210803
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Ho William Tai-Wei
CENTRAL INDEX KEY: 0001830914
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39692
FILM NUMBER: 211140676
MAIL ADDRESS:
STREET 1: C/O IN8BIO, INC.
STREET 2: 79 MADISON AVENUE
CITY: NEW YORK
STATE: NY
ZIP: 10016
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: IN8BIO, INC.
CENTRAL INDEX KEY: 0001740279
STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836]
IRS NUMBER: 825462585
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 79 MADISON AVENUE, 2ND FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10016
BUSINESS PHONE: (646) 600-6438
MAIL ADDRESS:
STREET 1: 79 MADISON AVENUE, 2ND FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10016
FORMER COMPANY:
FORMER CONFORMED NAME: Incysus Therapeutics, Inc.
DATE OF NAME CHANGE: 20180510
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-08-03
0
0001740279
IN8BIO, INC.
INAB
0001830914
Ho William Tai-Wei
C/O IN8BIO, INC.
79 MADISON AVENUE
NEW YORK
NY
10016
1
1
0
0
President, CEO and CFO
Common Stock
2021-08-03
4
C
0
3070
A
72999
I
By child
Common Stock
2289430
D
Common Stock
73000
I
By child
Common Stock
36500
I
See footnote
Common Stock
36500
I
See footnote
Common Stock
36500
I
See footnote
Series A Preferred Stock
2021-08-03
4
C
0
2792
0.00
D
Common Stock
3070
0
I
By child
Each share of Series A Preferred Stock was convertible at any time at the option of the holder, without payment of additional consideration, into
Common Stock, on a 1.0997 for 1 basis, had no expiration date and automatically converted into shares of Common Stock upon the
closing of the Issuer's initial public offering.
The shares are held by a relative of the Reporting Person. The Reporting Person has voting power pursuant to a voting proxy.
/s/ Jason Minio, Attorney-in-Fact
2021-08-03