SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
RiverVest Venture Fund IV, L.P.

(Last) (First) (Middle)
101 S. HANLEY ROAD, SUITE 1850

(Street)
ST. LOUIS MO 63105

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Xilio Therapeutics, Inc. [ XLO ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
10/26/2021
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 10/26/2021 C 832,120 A (1) 832,120 I See Footnotes(2)(3)
Common Stock 10/26/2021 C 359,324 A (1) 1,191,444 I See Footnotes(2)(3)
Common Stock 10/26/2021 P(4) 250,000(4) A $16 1,441,444 I See Footnotes(2)(3)(4)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series B Preferred Stock (1) 10/26/2021 C 832,120 (1) (1) Common Stock 832,120 $0.00 0 I See Footnotes(2)(3)
Series B Preferred Stock (1) 10/26/2021 C 359,324 (1) (1) Common Stock 359,324 $0.00 0 I See Footnotes(2)(3)
Explanation of Responses:
1. Each share of Series B Preferred Stock and Series C Preferred Stock automatically converted into 1 share of the Issuer's common stock upon the closing of the Issuer's initial public offering on October 26, 2021. The shares have no expiration date.
2. The shares held by RiverVest Venture Fund IV, L.P. ("RiverVest IV") are indirectly held by RiverVest Venture Partners IV, L.P. ("RiverVest Partners IV"), which is the general partner of RiverVest IV. RiverVest Venture Partners IV, LLC is the general partner of RiverVest Partners IV.
3. The individual managers of RiverVest Ventures Partners IV, LLC are Jay Schmelter, John P. McKearn, Ph.D. and Niall O'Donnell. RiverVest Partners IV, RiverVest Venture Partners IV, LLC and each of the individual managers share voting and dispositive power with regard to the securities directly held by RiverVest Venture Fund IV, L.P.
4. RiverVest IV purchased the shares in the Issuer's initial public offering.
Remarks:
/s/ Jay Schmelter, Manager of RiverVest Venture Partners IV, LLC 10/26/2021
** Signature of Reporting Person Date
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* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
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