Sec Form 3 Filing - THOMSON TODD S @ ACTUATE THERAPEUTICS, INC. - 2024-08-12

Insider filing report for Changes in Beneficial Ownership
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FORM 3
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
THOMSON TODD S
2. Issuer Name and Ticker or Trading Symbol
ACTUATE THERAPEUTICS, INC. [ ACTU]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) X __ Other (specify below)
16.4% Owner
(Last) (First) (Middle)
9440 S. SANTA MONICA BLVD, SUITE #710
3. Date of Earliest Transaction (MM/DD/YY)
08/12/2024
(Street)
BEVERLY HILLS, CA90210
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ 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 47,318 I By Kairos Venture Partners II, L.P. ( 1 ) ( 2 )
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 Security: 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 B-4 Preferred Stock ( 5 ) ( 3 ) ( 3 ) Common Stock 230,597 I By Kairos-Actuate SPV, L.P. ( 1 ) ( 2 )
Series C Preferred Stock ( 5 ) ( 3 ) ( 3 ) Common Stock 24.138 I By Kairos-Actuate SPV, L.P. ( 1 ) ( 2 )
Series B-1 Preferred Stock ( 5 ) ( 3 ) ( 3 ) Common Stock 1,058,318 I By KVP II, L.P. ( 1 ) ( 2 )
Series B-1 Warrants ( 4 ) ( 4 ) ( 4 ) Common Stock 40,261 ( 4 ) I By KVP II, L.P. ( 1 ) ( 2 )
Series B-3 Preferred Stock ( 5 ) ( 3 ) ( 3 ) Common Stock 69,445 I By KVP II, L.P. ( 1 ) ( 2 )
NSO Stock Option Grant $ 2.14 04/30/2024 04/29/2033 Common Stock 15,942 I By KVP II, L.P. ( 1 ) ( 2 )
Series B-2 Preferred Stock ( 5 ) ( 3 ) ( 3 ) Common Stock 726,163 I By KVOI, L.P. ( 1 ) ( 2 )
Series B-3 Preferred Stock ( 5 ) ( 3 ) ( 3 ) Common Stock 146,870 I By KVOI, L.P. ( 1 ) ( 2 )
Series B-3 Preferred Stock ( 5 ) ( 3 ) ( 3 ) Common Stock 138,889 I By Kairos SPV Fund, LLC ( 1 ) ( 2 )
Series B-4 Preferred Stock ( 5 ) ( 3 ) ( 3 ) Common Stock 132,908 I By Kairos SPV Fund, LLC ( 1 ) ( 2 )
Series C Preferred Stock ( 5 ) ( 3 ) ( 3 ) Common Stock 49,984 I By Kairos SPV Fund, LLC ( 1 ) ( 2 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
THOMSON TODD S
9440 S. SANT A MONICA BLVD
SUITE #710
BEVERLY HILLS, CA90210
X 16.4% Owner
Kairos SPV Fund LLC
9440 S. SANTA MONICA BLVD
SUITE #710
BEVERLY HILLS, CA90210
X 2% Owner
Kairos Venture Opportunities I, L.P.
9440 S. SANTA MONICA BLVD
SUITE #710
BEVERLY HILLS, CA90210
X 5.3% Owner
Kairos Venture Partners II, L.P.
9440 S. SANTA MONICA BLVD
SUITE #710
BEVERLY HILLS, CA90210
X 7.6% Owner
Kairos-Actuate SPV, L.P.
9440 S. SANTA MONICA BLVD
SUITE #710
BEVERLY HILLS, CA90210
X 1.5% Owner
Signatures
/s/ Todd Thomson 08/12/2024
Signature of Reporting Person Date
/s/ James T Demetriades, Kairos SPV Fund LLC 08/12/2024
Signature of Reporting Person Date
/s/ James T Demetriades, Kairos Venture Opportunities I, L.P. [KVOI, L.P.] 08/12/2024
Signature of Reporting Person Date
/s/ James T Demetriades, Kairos Venture Partners II, L.P. [KVP II, L.P.] 08/12/2024
Signature of Reporting Person Date
/s/ James T Demetriades, Kairos-Actuate SPV, L.P. 08/12/2024
Signature of Reporting Person Date
Explanation of Responses:
( 1 )The securities of Actuate Therapeutics, Inc. ("Actuate") that are reported herein are held directly by Kairos-Actuate SPV, L.P., Kairos Venture Partners II, L.P., Kairos Venture Opportunities I, L.P., and Kairos SPV Fund, LLC (collectively, the "Kairos Funds"). The Kairos Funds are managed and controlled by Kairos Venture Investments, LLC ("KVI"), subject to the Limited Partnership Agreements in place for each Kairos Fund. Todd Thomson serves as Chief Financial Officer/Chief Operating Officer of KVI and is a director on the board of directors of Actuate. James Demetriades is the Chief Executive Officer of KVI.
( 2 )Each of KVI, Mr. Thomson and Mr. Demetriades may be deemed to indirectly beneficially own the securities of Actuate held directly by the Kairos Funds. Each of KVI, Mr. Thomson and Mr. Demetriades disclaims beneficial ownership of the securities of Actuate held directly by the Kairos Funds except to the extent of its or his pecuniary interest therein, and this report shall not be deemed an admission that any of KVI, Mr. Thomson or Mr. Demetriades is the beneficial owner of such securities for purposes of Section 16 or any other purchase.
( 3 )Conversion timing occurs according to the terms and conditions stated in the Preferred Stock Purchase Agreement for each class. Conversion will occur automatically upon the closing of Actuate's initial public offering.
( 4 )There is no expiration date on the rights of the warrants issued. Conversion occurs according to conditions stated in the Note and Warrant Purchase Agreement. Conversion will occur automatically upon closing of Actuate's initial public offering. The conversion price and the number of shares to be issued upon the closing of Actuate's initial public offering is estimated currently and will finalize at pricing of IPO.
( 5 )Conversion occurs according to the terms and conditions stated in the Preferred Stock Purchase Agreement for each class. Conversion will occur automatically upon the closing of Actuate's initial public offering.

Remarks:
Todd Thomson serves as CFO/COO of Kairos Venture Investments, LLC and is a director on the board of directors of Actuate Therapeutics, Inc. ("Actuate"). Due to their relationship with Todd Thompson, for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, each of the Reporting Persons other than Todd Thompson are deemed to be directors by deputization of Actuate.

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).
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