| 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) 09/14/2021 | 3. Issuer Name and Ticker or Trading Symbol DICE Therapeutics, Inc. [ DICE ] | |||||||||||||
| 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 B Convertible Preferred Stock | (1) | (1) | Common Stock | 1,735,388 | (1) | I | By: Northpond Ventures, LP(4) |
| Series C Convertible Preferred Stock | (2) | (2) | Common Stock | 867,687 | (2) | I | By: Northpond Ventures, LP(4) |
| Series C-1 Convertible Preferred Stock | (3) | (3) | Common Stock | 454,796 | (3) | I | By: Northpond Ventures II, LP(5) |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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| Explanation of Responses: |
| 1. All shares of Series B Convertible Preferred Stock, par value $0.0001 per share (the "Series B Convertible Preferred Stock"), of DICE Therapeutics, Inc. (the "Issuer") will automatically convert on a one-for-one basis into shares of the Issuer's common stock, par value $0.0001 per share (the "Common Stock") prior to the closing of the Issuer's initial public offering of its Common Stock. The Series B Convertible Preferred Stock has no expiration date. |
| 2. All shares of Series C Convertible Preferred Stock, par value $0.0001 per share (the "Series C Convertible Preferred Stock"), of the "Issuer will automatically convert on a one-for-one basis into shares of the Issuer's Common Stock prior to the closing of the Issuer's initial public offering of its Common Stock. The Series C Preferred Stock has no expiration date. |
| 3. All shares of Series C-1 Convertible Preferred Stock, par value $0.0001 per share (the "Series C-1 Convertible Preferred Stock"), of the "Issuer will automatically convert on a one-for-one basis into shares of the Issuer's Common Stock prior to the closing of the Issuer's initial public offering of its Common Stock. The Series C-1 Preferred Stock has no expiration date. |
| 4. Northpond Ventures GP, LLC ("Northpond GP LLC") is the general partner of Northpond Ventures, LP ("Northpond Fund"), and Michael P. Rubin is the managing member of Northpond GP LLC. As a result, each of Northpond GP LLC and Mr. Rubin may be deemed to share beneficial ownership with respect to the shares held of record by Northpond Fund. Each of Northpond GP LLC and Mr. Rubin disclaim beneficial ownership of the securities reported herein, except to the extent of such Reporting Person's pecuniary interest therein, if any. |
| 5. Northpond Ventures GP II, LLC ("Northpond GP II LLC") is the general partner of Northpond Ventures II, LP ("Northpond Fund II"), and Michael P. Rubin is the managing member of Northpond GP II LLC. As a result, each of Northpond GP II LLC and Mr. Rubin may be deemed to share beneficial ownership with respect to the shares held of record by Northpond Fund II. Each of Northpond GP II LLC and Mr. Rubin disclaim beneficial ownership of the securities reported herein, except to the extent of such Reporting Person's pecuniary interest therein, if any. |
| Remarks: |
| Northpond Ventures GP, LLC By: /s/ Patrick Smerkers, Senior Vice President, Finance and Operations | 09/14/2021 | |
| Northpond Ventures, LP By: Northpond Ventures GP, LLC, its general partner By: /s/ Patrick Smerkers, Senior Vice President, Finance and Operations | 09/14/2021 | |
| Northpond Ventures GP II, LLC By: /s/ Patrick Smerkers, Senior Vice President, Finance and Operations | 09/14/2021 | |
| Northpond Ventures II, LP By: Northpond Ventures GP II, LLC, its general partner By: /s/ Patrick Smerkers, Senior Vice President, Finance and Operations | 09/14/2021 | |
| /s/ Michael P. Rubin | 09/14/2021 | |
| ** 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. | ||
