1. Name and Address of Reporting Person*SHV Management Services, LLC |
C/O SANTE VENTURES | 300 W 6TH STREET, SUITE 2300 |
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 08/01/2017 | 3. Issuer Name and Ticker or Trading Symbol Molecular Templates, Inc. [ MTEM ] |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable) | Director | X | 10% Owner | | Officer (give title below) | | Other (specify below) | |
| 5. If Amendment, Date of Original Filed (Month/Day/Year) 08/11/2017 |
6. Individual or Joint/Group Filing (Check Applicable Line) | Form filed by One Reporting Person | X | Form filed by More than One Reporting Person |
|
1. Name and Address of Reporting Person*SHV Management Services, LLC |
C/O SANTE VENTURES | 300 W 6TH STREET, SUITE 2300 |
(Street)
|
1. Name and Address of Reporting Person*
C/O SANTE VENTURES | 300 W 6TH STREET, SUITE 2300 |
(Street)
|
1. Name and Address of Reporting Person*
C/O SANTE VENTURES | 300 W 6TH STREET, SUITE 2300 |
(Street)
|
1. Name and Address of Reporting Person*SHV Management Services, LP |
300 W 6TH STREET, SUITE 2300 | |
(Street)
|
1. Name and Address of Reporting Person*SANTE HEALTH VENTURES I LP |
300 W 6TH STREET, SUITE 2300 | |
(Street)
|
1. Name and Address of Reporting Person*Sante Health Ventures I Annex Fund, LP |
300 W 6TH STREET, SUITE 2300 | |
(Street)
|
1. Name and Address of Reporting Person*
300 W 6TH STREET, SUITE 2300 | |
(Street)
|
| SHV MANAGEMENT SERVICES, LLC, By: Kevin Lalande, Its Managing Member, By: /s/ Jason S. Kim, Attorney in fact | 09/25/2017 |
| SHV MANAGEMENT SERVICES, L.P., By: SHV Management Services, LLC, Its general partner, By: Kevin Lalande, Its Managing Member, By: /s/ Jason S. Kim, Attorney in fact | 09/25/2017 |
| SANTE HEALTH VENTURES I, L.P., By: SHV Management Services, L.P., Its general partner, By: SHV Management Services, LLC, Its general partner, By: Kevin Lalande, Its Managing Member, By: /s/ Jason S. Kim, Attorney in fact | 09/25/2017 |
| SHV ANNEX SERVICES, L.P., By: SHV Management Services, LLC, Its general partner, By: Kevin Lalande, Its Managing Member, By: /s/ Jason S. Kim, Attorney in fact | 09/25/2017 |
| SANTE HEALTH VENTURES I ANNEX FUND, L.P., By: SHV Annex Services, LP, Its general partner, By: SHV Management Services, LLC, Its general partner, By: Kevin Lalande, Its Managing Member, By: /s/ Jason S. Kim, Attorney in fact | 09/25/2017 |
| JOE CUNNINGHAM, MD, By: /s/ Jason S. Kim, Attorney-in-Fact | 09/25/2017 |
| DOUGLAS D. FRENCH, By: /s/ Jason S. Kim, Attorney-in-Fact | 09/25/2017 |
| ** 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. |