| 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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 06/22/2023 |
3. Issuer Name and Ticker or Trading Symbol
Acrivon Therapeutics, Inc. [ ACRV ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Beneficially Owned | |||
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| 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) |
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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| 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 | ||||
| Explanation of Responses: |
| Remarks: |
| Exhibit List: Exhibit 24 - Power of Attorney |
| No securities are beneficially owned. |
| /s/ Rasmus Holm-Jorgensen, Attorney-in-Fact | 06/28/2023 | |
| ** 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. | ||
Exhibit 24
POWER OF ATTORNEY
(For Executing Form ID, Forms 3, 4 and 5, and Form 144)
Know all by these presents, that the undersigned hereby constitutes and appoints each of Peter Blume-Jensen, Rasmus
Holm-Jorgensen, Eric Devroe, Katharine Peterson and Mary-Alice Miller of Acrivon Therapeutics, Inc. (the “Company”), signing
individually, the undersigned's true and lawful attorneys-in-fact and agents to:
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(1)
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Prepare, execute in the undersigned's name and on the undersigned's behalf, and submit to the U.S. Securities and Exchange Commission (the
“SEC”) a Form ID, including amendments thereto, and any other documents necessary or appropriate to obtain codes and
passwords enabling the undersigned to make electronic filings with the SEC of reports required by Section 16 of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), Rule 144 under the Securities Act of 1933 (“Rule 144”), or
any rule or regulation of the SEC;
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(2)
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Execute for and on behalf of the undersigned, in the undersigned’s
capacity as an officer, director or beneficial owner of more than 10% of a registered class of securities of the Company, any and all reports on
Form 3, 4 or 5 in accordance with Section 16(a) of the Exchange Act and the rules thereunder, and on Form 144 in accordance with Rule 144 (including amendments thereto and joint filing agreements in connection therewith);
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(3)
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Do and perform any and all acts for and on behalf of the undersigned that may be necessary or desirable to prepare and execute any such
Forms 3, 4 or 5, or Form 144 (including amendments thereto and joint filing agreements in connection therewith) and timely file such forms with the SEC and any stock exchange, self-regulatory association or similar authority; and
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(4)
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Take any other action of any type whatsoever in connection with the foregoing that, in the opinion of such attorney-in-fact, may be of
benefit to, in the best interest of, or legally required of the undersigned, it being understood that the documents executed by the attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and
shall contain such terms and conditions as the attorney-in-fact may approve in the attorney-in-fact's discretion.
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The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing
whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or
revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. The
undersigned acknowledges that the foregoing attorneys-in-fact, and their substitutes, in serving in such capacity at the request of the undersigned, are not assuming (nor is the Company assuming) any of the undersigned's responsibilities to comply
with Section 16 of the Exchange Act or Rule 144.
This Power of Attorney shall remain in full force and effect until the earliest to occur of (a) the undersigned is no longer
required to file reports under Section 16(a) of the Exchange Act or Rule 144 with respect to the undersigned’s holdings of and transactions in securities issued by the Company, (b) revocation by the undersigned in a signed writing delivered to the
Company and the foregoing attorneys-in-fact, (c) as to any attorney-in-fact individually, until such attorney-in-fact is no longer employed by the Company, and (d) this Power of Attorney is superseded by a new power of attorney regarding the purposes
outlined herein at a later date.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of the date written below.
Date: April 27, 2023
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/s/ Charles M. Baum |
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Signature
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Charles M. Baum, MD, PhD
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Print Name
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