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