SEC FORM
3
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
|
OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
|
|
1. Name and Address of Reporting Person*
C/O WESTLAKE BIOPARTNERS, LLC |
3075 TOWNSGATE RD., SUITE 140 |
(Street)
WESTLAKE VILLAGE |
CA |
91361 |
|
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 |
X |
10% Owner |
|
Officer (give title below) |
|
Other (specify below) |
|
|
5. If Amendment, Date of Original Filed
(Month/Day/Year)
|
6. Individual or Joint/Group Filing (Check Applicable Line)
|
Form filed by One Reporting Person |
X |
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 |
Series A Redeemable Convertible Preferred Stock |
|
|
Class A Common Stock
|
4,056,795 |
|
D
|
|
Series B Redeemable Convertible Preferred Stock |
|
|
Class A Common Stock
|
2,445,786 |
|
D
|
|
Series C Redeemable Convertible Preferred Stock |
|
|
Class A Common Stock
|
2,038,148 |
|
D
|
|
1. Name and Address of Reporting Person*
C/O WESTLAKE BIOPARTNERS, LLC |
3075 TOWNSGATE RD., SUITE 140 |
(Street)
WESTLAKE VILLAGE |
CA |
91361 |
|
1. Name and Address of Reporting Person*
C/O WESTLAKE BIOPARTNERS, LLC |
3075 TOWNSGATE RD., SUITE 140 |
(Street)
WESTLAKE VILLAGE |
CA |
91361 |
|
1. Name and Address of Reporting Person*
C/O WESTLAKE BIOPARTNERS, LLC |
3075 TOWNSGATE RD., SUITE 140 |
(Street)
WESTLAKE VILLAGE |
CA |
91361 |
|
Explanation of Responses: |
Remarks: |
|
/s/ Jennifer L. Kercher, 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. |
Power of Attorney
Each of the undersigned entities and individuals (collectively, the "Reporting
Persons") hereby authorizes and designates Westlake BioPartners GP II, LLC or
such other person or entity as is designated in writing by Beth C. Seidenberg
(the "Designated Filer") as the beneficial owner to prepare and file on behalf
of such Reporting Person individually, or jointly together with the other
Reporting Persons, any and all reports, notices, communications and other
documents (including, but not limited to, reports on Form D, Form ADV, Schedule
13D, Schedule 13F, Schedule 13G, Schedule 13H, Form 3, Form 4 and Form 5) that
such Reporting Person may be required to file with the United States Securities
and Exchange Commission pursuant to the Securities Act of 1933, as amended
(together with the implementing regulations thereto, the "Act") and the
Securities Exchange Act of 1934, as amended (together with the implementing
regulations thereto, the "Exchange Act") or any other domestic or international
state, federal or national agency (collectively, the "Reports") with respect to
each Reporting Person's ownership of, or transactions in, securities of any
entity whose securities are beneficially owned (directly or indirectly) by such
Reporting Person (collectively, the "Companies").
Each Reporting Person hereby further (i) authorizes and designates Jennifer L.
Kercher (the "Authorized Signatory") to execute and file on behalf of such
Reporting Person the Reports and to perform any and all other acts, which in the
opinion of the Designated Filer or Authorized Signatory may be necessary or
incidental to the performance of the foregoing powers herein granted and (ii)
approves and ratifies all prior Reports executed and/or filed on behalf of each
such Reporting Person by the Authorized Signatory.
The authority of the Designated Filer and the Authorized Signatory under this
Power of Attorney with respect to each Reporting Person shall continue until
such Reporting Person is no longer required to file any Reports with respect to
the Reporting Person's ownership of, or transactions in, the securities of the
Companies, unless earlier revoked in writing. Each Reporting Person
acknowledges that the Designated Filer and the Authorized Signatory are not
assuming any of the Reporting Person's responsibilities to comply with the Act
or the Exchange Act.
Date: May 4, 2023
WESTLAKE BIOPARTNERS FUND II, L.P.
a Delaware Limited Partnership
By: Westlake BioPartners GP II, LLC
a Delaware Limited Liability Company
Its General Partner
By: /s/ Sean E. Harper
Sean E. Harper
Managing Director
By: /s/ Beth C. Seidenberg
Beth C. Seidenberg
Managing Director
WESTLAKE BIOPARTNERS GP II, LLC
a Delaware Limited Liability Company
By: /s/ Sean E. Harper
Sean E. Harper
Managing Director
By: /s/ Beth C. Seidenberg
Beth C. Seidenberg
Managing Director
BETH C. SEIDENBERG
By: /s/ Beth C. Seidenberg
SEAN E. HARPER
By: /s/ Sean E. Harper