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 |
| |||||||||||||||
1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 05/27/2021 | 3. Issuer Name and Ticker or Trading Symbol Centessa Pharmaceuticals plc [ CNTA ] | |||||||||||||
| 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)
| |||||||||||||||
| Table I - Non-Derivative Securities Beneficially Owned | |||
|---|---|---|---|
| 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) | |||||||
|---|---|---|---|---|---|---|---|
| 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 A Preferred Shares | (1) | (1) | Ordinary Shares(2) | 3,095,909 | (1) | I | See footnote(3) |
| Series A Preferred Shares | (1) | (1) | Ordinary Shares(2) | 85,909 | (1) | I | See footnote(4) |
| Explanation of Responses: |
| 1. Immediately prior to the closing of the initial public offering closing, Series A Preferred Shares will automatically convert on a one-to-one basis into Ordinary Shares without payment or further consideration. The resulting number of Ordinary Shares of the Issuer are shown in Column 3. The Series A Preferred Shares have no expiration date. |
| 2. Ordinary Shares may be represented by American Depositary Shares, each of which currently represents one Ordinary Share. |
| 3. Held by Vida Ventures II, LLC ("Vida II Main Fund"). VV Manager II, LLC ("VV Manager II") is the manager of Vida II Main Fund. The Reporting Person is a member of the investment committee of VV Manager II. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of any pecuniary interest therein. |
| 4. Held by Vida Ventures II-A, LLC ("Vida II Parallel Fund"). VV Manager II is the manager of Vida II Parallel Fund. The Reporting Person is a member of the investment committee of VV Manager II. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of any pecuniary interest therein. |
| Remarks: |
| Exhibit 24 - Power of Attorney |
| /s/ Marella Thorell, attorney-in-fact | 05/27/2021 | |
| ** 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. | ||