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*
Benz Edward J. JR

(Last) (First) (Middle)
C/O DECIPHERA PHARMACEUTICALS, INC.
500 TOTTEN POND ROAD

(Street)
WALTHAM MA 02451

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Deciphera Pharmaceuticals, Inc. [ DCPH ]
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)
10/02/2017
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
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) $3.95 10/02/2017 M 6,236(1) (2) 09/26/2026 Common Stock 35,233 (1) 0 D
Stock Option (Right to Buy) $3.95 10/02/2017 M 35,233(3) (2) 09/26/2026 Common Stock 35,233 (1) 35,233 D
Stock Option (Right to Buy) $6.13 10/02/2017 M 1,271(1) (4) 06/03/2027 Common Stock 7,181 (1) 0 D
Stock Option (Right to Buy) $6.13 10/02/2017 M 7,181(3) (4) 06/03/2027 Common Stock 7,181 (1) 7,181 D
Explanation of Responses:
1. Immediately prior to the closing of the Issuer's initial public offering, these options to purchase common stock of Deciphera Pharmaceuticals, LLC were exchanged for options to purchase common stock of the Issuer on a 1 for 5.65 basis pursuant to that certain Reorganization Agreement and Plan of Merger by and among the Issuer, Deciphera Pharmaceuticals, LLC and the other parties named therein, dated September 26, 2017 (the "Merger Agreement"). These transactions were exempt from Section 16(b) in reliance upon Rule 16b-3 and Rule 16b-6(b).
2. This stock option award was issued pursuant to Deciphera Pharmaceuticals, LLC's 2015 Equity Incentive Plan. The option vests in 48 equal monthly installments at the end of each month following the vesting commencement date of September 27, 2016, subject to continued service through such dates.
3. Represents the total number of options to purchase common stock of the Issuer received upon the exchange of options to purchase common stock of Deciphera Pharmaceuticals, Inc. for options to purchase common stock of the Issuer pursuant to the Merger Agreement.
4. This stock option award was issued pursuant to Deciphera Pharmaceuticals, LLC's 2015 Equity Incentive Plan. The option vests in 48 equal monthly installments at the end of each month following the vesting commencement date of May 26, 2017, subject to continued service through such dates.
Remarks:
/s/ Thomas P. Kelly, Attorney-in-Fact 10/02/2017
** 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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