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*
Perez Edith A.

(Last) (First) (Middle)
C/O BOLT BIOTHERAPEUTICS, INC.
900 CHESAPEAKE DRIVE

(Street)
REDWOOD CITY CA 94063

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/04/2021
3. Issuer Name and Ticker or Trading Symbol
Bolt Biotherapeutics, Inc. [ BOLT ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Medical Officer
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)
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
Stock Option (Right to Buy) (1) 07/28/2030 Common Stock 225,000 $2.8 D
Stock Option (Right to Buy) (2) 09/02/2030 Common Stock 12,142 $4.34 D
Stock Option (Right to Buy) (3) 09/02/2030 Common Stock 45,000 $4.34 D
Explanation of Responses:
1. 1/4th of the shares subject to the option shall vest on the one year anniversary of April 1, 2020 (the "Vesting Commencement Date"), and 1/48th of the shares shall vest each month thereafter on the same day of the month as the Vesting Commencement Date, subject to the Reporting Person continuing to be a service provider through each such date.
2. This option is immediately exercisable and vests over a four-year period with 1,770 shares vesting on April 3, 2021 and the remainder vesting monthly over 41 months from April 3, 2021.
3. This option is immediately exercisable and vests over a four-year period with 2,812 shares vesting on April 15, 2021 and the remainder vesting monthly over 45 months from April 15, 2021.
Remarks:
Exhibit 24 - Power of Attorney
/s/ Brian Woodard, Attorney-in-Fact 02/04/2021
** 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.