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*
Anderson Kenneth Carl

(Last) (First) (Middle)
C/O C4 THERAPEUTICS, INC.
490 ARSENAL WAY #200

(Street)
WATERTOWN MA 02472

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
C4 Therapeutics, Inc. [ CCCC ]
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)
01/26/2022
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 01/26/2022 M 803 A $2.11 86,641 D
Common Stock 01/26/2022 M 1,334 A $4.98 87,975 D
Common Stock 47,316 I By Spouse
Common Stock 61,265 I By Kenneth C. Anderson 2016 Grantor Retained Annuity Trust(1)
Common Stock 61,265 I By Cynthia E. Anderson 2016 Grantor Retained Annuity Trust(2)
Common Stock 16,939 I By Kenneth C. Anderson 2015 Irrevocable Trust(3)
Common Stock 16,939 I By Cynthia E. Anderson 2015 Irrevocable Trust(4)
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) $2.11 01/26/2022 M 803 (5) 07/12/2026 Common Stock 803 $0.00 2,137 D
Stock Option (Right to Buy) $4.98 01/26/2022 M 1,334 (6) 07/02/2030 Common Stock 1,334 $0.00 2,668 D
Explanation of Responses:
1. Shares held by the Kenneth C. Anderson 2016 Grantor Retained Annuity Trust. The Reporting Person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
2. Shares held by the Cynthia E. Anderson 2016 Grantor Retained Annuity Trust. The Reporting Person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
3. Shares held by the Kenneth C. Anderson 2015 Irrevocable Trust. The Reporting Person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
4. Shares held by the Cynthia E. Anderson 2015 Irrevocable Trust. The Reporting Person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
5. 12.5% of the shares underlying this option vested and became exercisable on December 31, 2016, with the remainder vesting in 28 equal quarterly installments thereafter.
6. The shares underlying this option vest and become exercisable in 12 equal quarterly installments, with the first installment vested on October 1, 2020.
Remarks:
/s/ Jolie M. Siegel, Attorney-in-Fact 01/26/2022
** 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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