Sec Form 4 Filing - Foy Matthew @ Decibel Therapeutics, Inc. - 2021-02-17

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Foy Matthew
2. Issuer Name and Ticker or Trading Symbol
Decibel Therapeutics, Inc. [ DBTX]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O DECIBEL THERAPEUTICS, INC., 1325 BOYLSTON STREET, SUITE 500
3. Date of Earliest Transaction (MM/DD/YY)
02/17/2021
(Street)
BOSTON, MA02215
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 02/17/2021 C 458,487 A 458,487 I See footnote ( 4 )
Common Stock 02/17/2021 C 247,324 A 705,811 I See footnote ( 4 )
Common Stock 02/17/2021 C 327,852 A 1,033,663 I See footnote ( 4 )
Common Stock 02/17/2021 P 150,000 A $ 18 1,183,663 I See footnote ( 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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 of Derivative Securit y: 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
Series A Preferred Stock ( 1 ) 02/17/2021 C 7,119,852 ( 1 ) ( 1 ) Common Stock 458,487 $ 0 0 I See footnote ( 4 )
Series C Preferred Stock ( 2 ) 02/17/2021 C 3,125,000 ( 2 ) ( 2 ) Common Stock 247,324 $ 0 0 I See footnote ( 4 )
Series D Preferred Stock ( 3 ) 02/17/2021 C 1,737,619 ( 3 ) ( 3 ) Common Stock 327,852 $ 0 0 I See footnote ( 4 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Foy Matthew
C/O DECIBEL THERAPEUTICS, INC.
1325 BOYLSTON STREET, SUITE 500
BOSTON, MA02215
X X
Signatures
/s/ Ronald Vigliotta, Attorney-in-Fact 02/19/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )On February 17, 2021, the Series A Preferred Stock automatically converted into Common Stock on a 15.529-for-one basis without payment of further consideration upon closing of the initial public offering of the Issuer's common stock. The shares had no expiration date.
( 2 )On February 17, 2021, the Series C Preferred Stock automatically converted into Common Stock on a 12.6352-for-one basis without payment of further consideration upon closing of the initial public offering of the Issuer's common stock. The shares had no expiration date.
( 3 )On February 17, 2021, the Series D Preferred Stock automatically converted into Common Stock on a 5.3-for-one basis without payment of further consideration upon closing of the initial public offering of the Issuer's common stock. The shares had no expiration date.
( 4 )Held of record by GSK Equity Investments, Limited ("GSK"), an indirect, wholly owned subsidiary of GlaxoSmithKline plc. SR One Capital Management, LP ("S.R. One") is the investment advisor for GSK. Mr. Foy is a partner at S.R. One. Mr. Foy disclaims beneficial ownership of all the shares reported herein and this report shall not be deemed an admission of beneficial ownership of such shares for the purposes of Section 16 or for any other purpose except to the extent of his proportionate pecuniary interest therein.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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