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*
Blume-Jensen Peter

(Last) (First) (Middle)
C/O ACRIVON THERAPEUTICS, INC.
480 ARSENAL WAY, SUITE 100

(Street)
WATERTOWN MA 02472

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Acrivon Therapeutics, Inc. [ ACRV ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President and CEO
3. Date of Earliest Transaction (Month/Day/Year)
11/14/2022
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 11/14/2022 A(1) 934,731 A $0.00 1,806,588 D
Common Stock 11/14/2022 A(2) 503,419 A $0.00 2,310,007 D
Common Stock 11/14/2022 A(3) 60,090 A $0.00 2,370,097 D
Common Stock 11/14/2022 A(4) 26,707 A $0.00 320,705 I See footnote(5)
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
Stock Option (Right to Buy) $12.5 11/14/2022 A 180,269 (6) 11/13/2032 Common Stock 180,269 $0.00 180,269 D
Stock Option (Right to Buy) $12.5 11/14/2022 A 80,120 (6) 11/13/2032 Common Stock 80,120 $0.00 80,120 I See footnote(5)
Explanation of Responses:
1. These shares represent restricted stock units ("RSUs"). Each RSU represents a contingent right to receive one share of the Issuer's Common Stock. Of these RSUs, 1/3rd of the RSUs shall vest on the one-year anniversary of the grant date, and the remaining RSUs shall vest in eight equal quarterly installments thereafter, in each case subject to the Reporting Person's continuous service through each such vesting date. This RSU grant to the Reporting Person constitutes a number of shares equal to 3.5% of the total outstanding shares of the Issuer as of the pricing of the Issuer's initial public offering, on a fully diluted basis after giving effect to the offering.
2. These shares represent RSUs. Each RSU represents a contingent right to receive one share of the Issuer's Common Stock. Of these RSUs, 1/3rd of the RSUs shall vest on the one-year anniversary of the grant date, and the remaining RSUs shall vest in eight equal quarterly installments thereafter, in each case subject to the Reporting Person's continuous service through each such vesting date. This RSU grant to the Reporting Person constitutes a number of shares equal to 1.885% of the total outstanding shares of the Issuer as of the pricing of the Issuer's initial public offering, on a fully diluted basis after giving effect to the offering, meant to cover estimated tax liability at the time of settlement of the RSU award referred to in footnote 1.
3. These shares represent RSUs. Each RSU represents a contingent right to receive one share of the Issuer's Common Stock. Of these RSUs, twenty-five percent (25%) of the RSUs shall vest on the one-year anniversary of the grant date, and the remaining RSUs shall vest in 12 equal quarterly installments thereafter, in each case subject to the Reporting Person's continuous service through each such vesting date.
4. These shares represent RSUs. Each RSU represents a contingent right to receive one share of the Issuer's Common Stock.
5. These securities are held by Dr. Blume-Jensen's spouse. Dr. Blume-Jensen disclaims beneficial ownership of such securities except to the extent of his pecuniary interest therein.
6. Twenty-five percent (25%) of the shares subject to the option shall vest on the one-year anniversary of the grant date, and the remaining shares subject to the option shall vest in 36 equal monthly installments thereafter, in each case subject to the Reporting Person's continuous service through each such vesting date.
Remarks:
/s/ Rasmus Holm-Jorgensen, Attorney-in-Fact 11/16/2022
** 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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