SEC FORM 3

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^*

Anderson Kenneth Carl

(Last)

(First)

(Middle)

C/O C4 THERAPEUTICS, INC.

490 ARSENAL WAY, SUITE 200

(Street)

WATERTOWN

02472

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
10/01/2020

3. Issuer Name and Ticker or Trading Symbol
C4 Therapeutics, Inc. [ CCCC ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
	Officer (give title below)	Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

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)
Common Stock	62,336	D
Common Stock	26,998	I	By Spouse
Common Stock	22,299	I	By Kenneth C. Anderson 2016 Grantor Retained Annuity Trust⁽¹⁾
Common Stock	22,299	I	By Cynthia E. Anderson 2016 Grantor Retained Annuity Trust⁽²⁾

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)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	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)
Series A Preferred Stock	⁽³⁾	⁽³⁾	Common Stock	18,040	⁽³⁾	D
Series A Preferred Stock	⁽³⁾	⁽³⁾	Common Stock	18,040	⁽³⁾	I	By Spouse
Series A Preferred Stock	⁽³⁾	⁽³⁾	Common Stock	41,244	⁽³⁾	I	By Kenneth C. Anderson 2016 Grantor Retained Annuity Trust⁽¹⁾
Series A Preferred Stock	⁽³⁾	⁽³⁾	Common Stock	41,244	⁽³⁾	I	By Cynthia E. Anderson 2016 Grantor Retained Annuity Trust⁽²⁾
Series B Preferred Stock	⁽³⁾	⁽³⁾	Common Stock	16,939	⁽³⁾	I	By Kenneth C. Anderson 2015 Irrevocable Trust⁽⁴⁾
Series B Preferred Stock	⁽³⁾	⁽³⁾	Common Stock	16,939	⁽³⁾	I	By Cynthia E. Anderson 2015 Irrevocable Trust⁽⁵⁾
Stock Option (Right to Buy)	⁽⁶⁾	07/12/2026	Common Stock	3,745	$2.11	D
Stock Option (Right to Buy)	⁽⁷⁾	07/12/2026	Common Stock	118	$2.11	D
Stock Option (Right to Buy)	⁽⁸⁾	07/02/2030	Common Stock	5,335	$4.98	D

Explanation of Responses:

1. Shares held by the Kenneth C. Anderson 2016 Grantor Retained Annuity Trust. The Reporting Person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.

2. Shares held the Cynthia E. Anderson 2016 Grantor Retained Annuity Trust. The Reporting Person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.

3. Share of Series A Preferred Stock and Series B Preferred Stock are convertible into Common Stock on a 8.4335-to-one basis into the aggregate number of shares of Common Stock shown in Column 3 at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering without payment or further consideration. The shares have no expiration date.

4. Shares held by the Kenneth C. Anderson 2015 Irrevocable Trust. The Reporting Person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.

5. Shares held the Cynthia E. Anderson 2015 Irrevocable Trust. The Reporting Person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.

6. Represents underlying unexercised stock options that were granted on July 13, 2016. The terms of the original grant provide that 12.5% of this option vested and became exercisable on December 31, 2016, with the remainder vesting in 28 equal quarterly installments thereafter.

7. Represents underlying unexercised stock options that were granted on July 13, 2016. The terms of the original grant provide that 20% of this option vested and became exercisable on January 1, 2017, with the remainder vesting in 16 equal quarterly installments thereafter.

8. This option shall vest and become exercisable in 12 equal quarterly installments, with the first installment vesting on October 1, 2020.

Remarks:

Exhibit 24 - Power of Attorney

	/s/ Jolie M. Siegel, Attorney-in-Fact	10/01/2020
	** 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.
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