0000899243-20-028343.txt : 20201015 0000899243-20-028343.hdr.sgml : 20201015 20201015172504 ACCESSION NUMBER: 0000899243-20-028343 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201014 FILED AS OF DATE: 20201015 DATE AS OF CHANGE: 20201015 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Brous Tyler CENTRAL INDEX KEY: 0001827387 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39593 FILM NUMBER: 201242170 MAIL ADDRESS: STREET 1: 1018 W 11TH ST., SUITE 100 CITY: AUSTIN STATE: TX ZIP: 78703 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Shattuck Labs, Inc. CENTRAL INDEX KEY: 0001680367 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 812575858 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1018 W. 11TH STREET CITY: AUSTIN STATE: TX ZIP: 78703 BUSINESS PHONE: 919-864-2700 MAIL ADDRESS: STREET 1: 1018 W. 11TH STREET CITY: AUSTIN STATE: TX ZIP: 78703 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2020-10-14 0 0001680367 Shattuck Labs, Inc. STTK 0001827387 Brous Tyler C/O SHATTUCK LABS, INC. 1018 W. 11TH STREET, SUITE 100 AUSTIN TX 78703 1 0 0 0 Common Stock 2020-10-14 4 C 0 629432 A 682177 I See Footnote Common Stock 2020-10-14 4 C 0 16440 A 16440 I See Footnote Common Stock 2020-10-14 4 C 0 27235 A 27235 I See Footnote Common Stock 2020-10-14 4 C 0 87132 A 87132 I See Footnote Common Stock 30825 D Series A Preferred Stock 2020-10-14 4 C 0 91888 0.00 D Common Stock 629432 0 I See Footnote Series A Preferred Stock 2020-10-14 4 C 0 2400 0.00 D Common Stock 16440 0 I See Footnote Series B Preferred Stock 2020-10-14 4 C 0 3976 0.00 D Common Stock 27235 0 I See Footnote Series B-1 Preferred Stock 2020-10-14 4 C 0 12720 0.00 D Common Stock 87132 0 I See Footnote Each share of Series A Preferred Stock automatically converted into 6.85 shares of the Issuer's common stock immediately prior to the closing of the Issuer's initial public offering (the "IPO") and had no expiration date. These shares are held directly by Lennox Dallas Partners, LP ("Lennox Partners"). The Reporting Person is the vice president of RS Holdings, Inc., the general partner of Lennox Partners. The Reporting Person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except the extent of his pecuniary interest therein. These shares are held directly by Lennox Dallas Holdings, LLC - Series 3. The Reporting Person is the Manager of Lennox Dallas Holdings, LLC - Series 3. The Reporting Person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except the extent of his pecuniary interest therein. Each share of Series B Preferred Stock automatically converted into 6.85 shares of the Issuer's common stock immediately prior to the closing of the IPO and had no expiration date. These shares are held directly by Lennox Dallas Holdings, LLC - Series 9. The Reporting Person is the Manager of Lennox Dallas Holdings, LLC - Series 9. The Reporting Person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except the extent of his pecuniary interest therein. Each share of Series B-1 Preferred Stock automatically converted into 6.85 shares of the Issuer's common stock immediately prior to the closing of the IPO and had no expiration date. These shares are held directly by Lennox Dallas Holdings, LLC - Series 10. The Reporting Person is the Manager of Lennox Dallas Holdings, LLC - Series 10. The Reporting Person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except the extent of his pecuniary interest therein. /s/ Erin Ator Thomson, Attorney-in-Fact for Tyler Brous 2020-10-15