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
 
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1. Name and Address of Reporting Person*
Kleiner Perkins Caufield & Byers XV, LLC

(Last) (First) (Middle)
C/O KLEINER PERKINS CAUFIELD & BYERS
2750 SAND HILL ROAD

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/30/2019
3. Issuer Name and Ticker or Trading Symbol
RAPT Therapeutics, Inc. [ RAPT ]
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 Preferred Stock (1) (1) Common Stock 2,871,492(2) (1) I By KPCB Holdings, Inc., as nominee(3)
Series B Preferred Stock (1) (1) Common Stock 166,666(2) (1) I By KPCB Holdings, Inc., as nominee(3)
Series C Preferred Stock (1) (1) Common Stock 363,504(2) (1) I By KPCB Holdings, Inc., as nominee(3)
Series C-2 Preferred Stock (1) (1) Common Stock 145,401(2) (1) I By KPCB Holdings, Inc., as nominee(3)
1. Name and Address of Reporting Person*
Kleiner Perkins Caufield & Byers XV, LLC

(Last) (First) (Middle)
C/O KLEINER PERKINS CAUFIELD & BYERS
2750 SAND HILL ROAD

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
KPCB XV Associates, LLC

(Last) (First) (Middle)
C/O KLEINER PERKINS CAUFIELD & BYERS
2750 SAND HILL ROAD

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
KPCB XV Founders Fund, LLC

(Last) (First) (Middle)
C/O KLEINER PERKINS CAUFIELD & BYERS
2750 SAND HILL ROAD

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
Explanation of Responses:
1. Each share of Series A, Series B, Series C and Series C-2 Preferred Stock is convertible into approximately 0.166 shares of the Issuer's common stock upon the closing of the Issuer's initial public offering (on an adjusted basis, after giving effect to the 1-for-6 reverse stock split of the common stock effected by the Issuer on July 19, 2019). Shares of Series A, Series B, Series C and Series C-2 Preferred Stock have no expiration date and will automatically convert into shares of the Issuer's common stock upon the closing of the Issuer's initial public offering of common stock, for no additional consideration.
2. The number of shares of common stock reflects a 1-for-6 reverse stock split, which became effective July 19, 2019.
3. The shares held for convenience in the name of KPCB Holdings, Inc., as nominee for the accounts of the following entities as follows: 3,444,199 shares held for the account of Kleiner Perkins Caufield & Byers XV, LLC ("KPCB XV") and 102,864 shares held for the account of KPCB XV Founders Fund, LLC ("KPCB XV FF"). The managing member of KPCB XV and KPCB XV FF is KPCB XV Associates, LLC ("KPCB XV Associates"). Beth Seidenberg, L. John Doerr, Randy Komisar, Theodore E. Schlein, Wen Hsieh and William "Bing" Gordon, the managing members of KPCB XV Associates, exercise shared voting and dispositive control over the shares held by KPCB Holdings, Inc. as nominee for the accounts of KPCB XV and KPCB XV FF.
Remarks:
/s/ Susan Biglieri, Chief Financial Officer 10/30/2019
** 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).
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