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) 10/15/2020 | 3. Issuer Name and Ticker or Trading Symbol Aligos Therapeutics, Inc. [ ALGS ] | |||||||||||||
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) |
Common Stock | 1,026,991(1) | D | |
Common Stock | 69,744(1) | I | Trust(2) |
Common Stock | 69,744(1) | I | Trust(3) |
Common Stock | 35,408(1) | I | Trust(4) |
Common Stock | 35,408(1) | I | Trust(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 | ||||
Stock Option (Right to Buy) | (6) | 02/19/2030 | Common Stock | 65,849(1) | 3.45(1) | D | |
Stock Option (Right to Buy) | (6) | 02/19/2030 | Common Stock | 202,399(1) | 3.45(1) | D | |
Series A Preferred Stock | (7) | (7) | Common Stock | 163,842(1)(7) | (7) | I | Trust(8) |
Series A Preferred Stock | (7) | (7) | Common Stock | 13,559(1)(7) | (7) | I | Trust(9) |
Series A Preferred Stock | (7) | (7) | Common Stock | 13,559(1)(7) | (7) | I | Trust(10) |
Series B-1 Preferred Stock | (7) | (7) | Common Stock | 50,781(1)(7) | (7) | I | Trust(8) |
Series B-1 Preferred Stock | (7) | (7) | Common Stock | 3,359(1)(7) | (7) | I | Trust(9) |
Series B-1 Preferred Stock | (7) | (7) | Common Stock | 3,359(1)(7) | (7) | I | Trust(10) |
Series B-2 Preferred Stock | (7) | (7) | Common Stock | 21,724(1)(7) | (7) | I | Trust(8) |
Series B-2 Preferred Stock | (7) | (7) | Common Stock | 1,437(1)(7) | (7) | I | Trust(9) |
Series B-2 Preferred Stock | (7) | (7) | Common Stock | 1,437(1)(7) | (7) | I | Trust(10) |
Explanation of Responses: |
1. Reflects a 1-for-9.3197 reverse stock split of the Issuer's outstanding securities effected prior to the effectiveness of the Issuer's S-1 Registration Statement. |
2. Leonid Beigelman and Natalia Lozovsky, Trustees, or their successors in trust, under the Beigelman 2020 Grantor Retained Annuity Trust dated June 25, 2020. |
3. Natalia Lozovsky and Leonid Beigelman, Trustees, or their successors in trust, under the Lozovsky 2020 Grantor Retained Annuity Trust dated June 25, 2020. |
4. Leonid Beigelman and Natalia Lozovsky, Trustees, or their successors in trust, under the Dina Beigelman 2020 Irrevocable Trust, dated July 02, 2020. |
5. Leonid Beigelman and Natalia Lozovsky, Trustees, or their successors in trust, under the Victor Beigelman 2020 Irrevocable Trust, dated July 02, 2020. |
6. The shares subject to the option are early exercisable. 1/48th of the total number of shares vest in forty-eight (48) successive and equal monthly installments measured from December 23, 2019 (the "Vesting Commencement Date"), such that 100% of the shares subject to the option will be fully vested and exercisable on the fourth anniversary of the Vesting Commencement Date. |
7. At any time at the holder's election or automatically upon the closing of the Issuer's initial public offering, shares of the Issuer's preferred stock will convert into shares of the Issuer's common stock on a one for one basis without payment or consideration. The preferred stock has no expiration date. |
8. Beigelman and Lozovsky Living Trust. |
9. Dina Beigelman Irrevocable Trust. |
10. Victor Beigelman Irrevocable Trust. |
/s/ Lucinda Y. Quan, as attorney-in fact for Leonid Beigelman | 10/15/2020 | |
** 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. |