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*
GOYAL ARJUN

(Last) (First) (Middle)
C/O CENTESSA PHARMACEUTICALS PLC
3RD FLOOR, 1 ASHLEY RD, ALTRINCHAM

(Street)
CHESHIRE X0 WA14 2DT

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Centessa Pharmaceuticals plc [ CNTA ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
06/02/2021
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
Ordinary Shares(1) 06/02/2021 C 3,095,909 A (2) 3,095,909 I See footnote(3)
Ordinary Shares(1) 06/02/2021 C 85,909 A (2) 85,909 I See footnote(4)
Ordinary Shares(1) 06/02/2021 P 729,750 A $20 3,825,659 I See footnote(3)
Ordinary Shares(1) 06/02/2021 P 20,250 A $20 106,159 I See footnote(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 A Preferred Shares (2) 01/29/2021 A(5) 3,095,909(6) (2) (2) Ordinary Shares(1) 3,095,909(6) $11(6) 3,095,909(6) I See footnote(3)
Series A Preferred Shares (2) 01/29/2021 A(5) 85,909(6) (2) (2) Ordinary Shares(1) 85,909(6) $11(6) 85,909(6) I See footnote(4)
Series A Preferred Shares (2) 06/02/2021 C 3,095,909 (2) (2) Ordinary Shares(1) 3,095,909 $0.00 0 I See footnote(3)
Series A Preferred Shares (2) 06/02/2021 C 85,909 (2) (2) Ordinary Shares(1) 85,909 $0.00 0 I See footnote(4)
Explanation of Responses:
1. The Ordinary Shares may be represented by American Depositary Shares, each of which currently represents one Ordinary Share.
2. Immediately prior to the closing of the initial public offering, the Series A Preferred Shares automatically converted on a one-to-one basis into Ordinary Shares without payment or further consideration. The Series A Preferred Shares had no expiration date.
3. Held by Vida Ventures II, LLC ("Vida II Main Fund"). VV Manager II, LLC ("VV Manager II") is the manager of Vida II Main Fund. The Reporting Person is a member of the investment committee of VV Manager II. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of any pecuniary interest therein.
4. Held by Vida Ventures II-A, LLC ("Vida II Parallel Fund"). VV Manager II is the manager of Vida II Parallel Fund. The Reporting Person is a member of the investment committee of VV Manager II. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of any pecuniary interest therein.
5. This transaction occurred prior to the effectiveness of the Issuer's registration under Section 12 of the Securities Exchange Act of 1934 and is being reported on Form 4 solely for purposes of compliance with Rule 16a-2(a) under the Securities Exchange Act of 1934, as amended. The securities covered by such transaction were previously included on the Reporting Person's Form 3.
6. On May 20, 2021, the Issuer effected a share capital reorganization, which had the effect of a one for two reverse share split of the Issuer's share capital ("Share Split"). This amount has been adjusted to give effect to the Share Split.
Remarks:
/s/ Marella Thorell, attorney-in-fact 06/04/2021
** 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 4 (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).
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