Statement of Ownership (sc 13g)
February 12 2020 - 4:47PM
Edgar (US Regulatory)
SCHEDULE 13G
Under the Securities Exchange Act of 1934
(Amendment No. __)
CASTLE BIOSCIENCES, INC.
(Name of Issuer)
Common Stock
(Title of Class of Securities)
14843C 105
(CUSIP Number)
December 31, 2019
(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
* The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures
provided in a prior cover page.
The information required in the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but
shall be subject to all other provisions of the Act (however, see the Notes).
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1
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Names of Reporting Persons
Derek J. Maetzold
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2
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Check the Appropriate Box if a Member of a Group
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(a)
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☐
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(b)
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☐
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3
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SEC Use Only
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4
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Citizenship or Place of Organization
United States of America
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Number of
Shares
Beneficially
Owned by
Each
Reporting
Person With:
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5
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Sole Voting Power
1,953,215 Shares (1)
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6
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Shared Voting Power
0 Shares
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7
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Sole Dispositive Power
1,953,215 Shares (1)
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8
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Shared Dispositive Power
0 Shares
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9
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Aggregate Amount Beneficially Owned by Each Reporting Person
1,953,215 Shares
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10
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Check if the Aggregate Amount in Row (9) Excludes Certain Shares ☐
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11
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Percent of Class Represented by Amount in Row (9)
11.3% (2)
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12
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Type of Reporting Person
IN
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(1) Includes (a) 217,165 shares of common stock issuable within 60 days of December 31, 2019 upon the exercise of stock options held by the Reporting Person, and (b) 164,068 shares held in
the name of the DJM Grantor Retained Annuity Trust No. 1, of which the Reporting Person is the Trustee.
(2) This percentage is calculated based on 17,074,049 shares of common stock outstanding as of November 7, 2019, as reported in the Issuer’s Quarterly Report on Form 10-Q filed on November
12, 2019.
CUSIP No. 1483C-105
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13G
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Page 3 of 5 Pages
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Item 1(a).
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Name of Issuer:
Castle Biosciences, Inc.
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Item 1(b).
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Address of Issuer’s Principal Executive Offices:
820 S. Friendswood Drive, Suite 201
Friendswood, TX 77546
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Item 2(a).
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Names of Persons Filing:
Derek J. Maetzold
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Item 2(b).
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Address of Principal Business Office, or, if none, Residence:
820 S. Friendswood Drive, Suite 201
Friendswood, TX 77546
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Item 2(c).
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Citizenship:
United States of America
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The following information with respect to the ownership of the Common Stock of the Issuer by the Reporting Person is provided as of December 31, 2019:
CUSIP No. 1483C-105
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13G
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Page 4 of 5 Pages
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Item 7.
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Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company or Control Person
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Not applicable
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Item 8.
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Identification and Classification of Members of the Group
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Not applicable
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Item 9.
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Notice of Dissolution of Group
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Not applicable
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CUSIP No. 1483C-105
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13G
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Page 5 of 5 Pages
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SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
Dated: February 12, 2020
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