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*
THIEL PETER

(Last) (First) (Middle)
9200 SUNSET BOULEVARD
SUITE 1110

(Street)
WEST HOLLYWOOD CA 90069

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
03/16/2021
3. Issuer Name and Ticker or Trading Symbol
Chemomab Therapeutics Ltd. [ CMMB ]
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)
X Form filed by One Reporting Person
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)
American Depositary Shares 877,973(1)(2) I See Footnote(3)
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
Explanation of Responses:
1. Received in exchange for 34,129 Preferred B Shares and 34,130 Preferred C Shares of Chemomab Ltd. in connection with the merger of Chemomab Ltd. into Anchiano Therapeutics Ltd. effective on March 16, 2021 (the "Merger"). Reflects a 4:1 reverse stock split of Ordinary Shares and increase in the number of Ordinary Shares per ADS from 5 to 20 effected by the Issuer in connection with the closing of the Merger.
2. Each American Depositary Share ("ADS") currently represents twenty (20) Ordinary Shares of the Issuer.
3. These securities are held of record by Rivendell Investments 2017-9 LLC. The Reporting Person is the beneficial owner of Rivendell Investments 2017-9 LLC and has sole voting and investment power over the securities held by Rivendell Investments 2017-9 LLC.
Remarks:
/s/ Peter Thiel 03/18/2021
** 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).
** 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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.