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*
Peloso Paul

(Last) (First) (Middle)
C/O ACELYRIN, INC.
4149 LIBERTY CANYON RD.

(Street)
AGOURA HILLS CA 91301

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/04/2023
3. Issuer Name and Ticker or Trading Symbol
ACELYRIN, Inc. [ SLRN ]
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
Employee Stock Option (right to buy) (1) 07/25/2031 Class A Common Stock(2) 173,681 $0.7683 D
Employee Stock Option (right to buy) (3) 01/19/2032 Class A Common Stock(2) 156,500 $4.0426 D
Employee Stock Option (right to buy) (4) 11/20/2032 Class A Common Stock(2) 187,988 $5.8766 D
Explanation of Responses:
1. 1/4 of the shares subject to the option vested on May 16, 2022 and 1/48 of the shares subject to the option vests in equal monthly installments thereafter, subject to the Reporting Person's continued service.
2. Each share of Class A Common Stock shall be reclassified into one share of Common Stock immediately prior to the completion of the Issuer's initial public offering of Common Stock.
3. 1/4 of the shares subject to the option vested on January 20, 2023, and 1/48 of the shares subject to the option vest in equal monthly installments thereafter, subject to the Reporting Person's continued service.
4. 1/4 of the shares subject to the option vest on November 17, 2023, and 1/48 of the shares subject to the option vests in equal monthly installments thereafter, subject to the Reporting Person's continued service.
Remarks:
Exhibit 24 - Power of Attorney
/s/ Mina Kim, Attorney-in-fact 05/04/2023
** 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.