SEC Form 3
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)
| 2. Date of Event Requiring Statement (Month/Day/Year) 11/04/2021 | 3. Issuer Name and Ticker or Trading Symbol IO Biotech, Inc. [ IOBT ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
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 | ||||
Series C Preferred Stock | (1) | (1) | Common Stock | 796,059 | (1) | I | See footnote(2) |
Series C Preferred Stock | (1) | (1) | Common Stock | 267,977 | (1) | I | See footnote(3) |
Explanation of Responses: |
1. Upon the closing of the Issuer's initial public offering ("IPO"), each share of Series C Preferred Stock beneficially owned by the reporting person will automatically convert, for no additional consideration, into the number of shares of Common Stock reported in Column 3. These shares of Series C Preferred Stock have no expiration date. |
2. The securities are held by Kurma Biofund III FPCI. Kurma Partners is the management company of Kurma Biofund III FPCI. The reporting person is a member of the board of directors of Kurma Partners, and may be deemed to share voting and investment power with respect to the shares beneficially owned by Kurma Biofund III FPCI and disclaims Section 16 beneficial ownership of such securities held by Kurma Biofund III FPCI, except to the extent of her pecuniary interest therein, if any. |
3. The securities are held by SKCI FPCI. Kurma Partners is the management company of SKCI FPCI. The reporting person is a member of the board of directors of Kurma Partners, and may be deemed to share voting and investment power with respect to the shares beneficially owned by SKCI FPCI and disclaims Section 16 beneficial ownership of such securities held by SKCI FPCI, except to the extent of her pecuniary interest therein, if any. |
Remarks: |
Exhibit List: Exhibit 24 - Power of Attorney |
/s/ Brian Burkavage, Attorney-in-Fact for Vanessa Malier | 11/04/2021 | |
** 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. |