UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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 control number. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series A Preferred Stock, par value $0.01 | (4) | (4) | Common Stock | 41,535 (3) | $ (4) | I | See Footnote (1) |
Series A Preferred Stock, par value $0.01 | (4) | (4) | Common Stock | 292,605 (3) | $ (4) | I | See Footnote (5) |
Series A Preferred Stock, par value $0.01 | (4) | (4) | Common Stock | 131,697 (3) | $ (4) | I | See Footnote (6) |
Series A Preferred Stock Warrant (right to buy) | (7) | (8) | Common Stock | 23,733 (3) | $ 5.45 | I | See Footnote (5) |
Series A Preferred Stock Warrant (right to buy) | (7) | (8) | Common Stock | 15,804 (3) | $ 5.45 | I | See Footnote (6) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Green Park & Golf Ventures II, LLC 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
X | |||
GPG LPI Investment, LLC 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
X | |||
Lantern 3-19 Investment, LLC 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
X | |||
Health Wildcatters Fund II, LLC 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
X | |||
Health Wildcatters, LLC 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
X | |||
Green Park & Golf Ventures, LLC 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
X | |||
Garcia Gilbert G. II 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
X | |||
Heighten Clay M 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
X | |||
Soderstrom Carl D 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
X |
/s/ Gilbert G. Garcia II (8) | 06/10/2020 | |
**Signature of Reporting Person | Date | |
/s/ Gilbert G. Garcia II (9) | 06/10/2020 | |
**Signature of Reporting Person | Date | |
/s/ Gilbert G. Garcia II (10) | 06/10/2020 | |
**Signature of Reporting Person | Date | |
/s/ Gilbert G. Garcia II (11) | 06/10/2020 | |
**Signature of Reporting Person | Date | |
/s/ Gilbert G. Garcia II (12) | 06/10/2020 | |
**Signature of Reporting Person | Date | |
/s/ Gilbert G. Garcia II (13) | 06/10/2020 | |
**Signature of Reporting Person | Date | |
/s/ Gilbert G. Garcia II | 06/10/2020 | |
**Signature of Reporting Person | Date | |
/s/ Clay M. Heighten, M.D. | 06/10/2020 | |
**Signature of Reporting Person | Date | |
/s/ Carl D. Soderstrom | 06/10/2020 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | These securities are directly held by Health Wildcatters Fund II, LLC ("HWF II"). Carl D. Soderstrom and Clay M. Heighten, M.D. are the managing members of Green Park & Golf Ventures, LLC ("GPG"), which is the managing member of Health Wildcatters, LLC ("HW"), which is the managing member of HWF II. Therefore, Carl D. Soderstrom, Clay M. Heighten, M.D., GPG, and HW may be deemed to beneficially own these securities. |
(2) | The Reporting Person acquired these shares of the Issuer's Common Stock, par value $0.0001 (the "Common Stock"), in connection with a series of private transactions conducted prior to the Issuer's initial public offering which commenced on June 10, 2020 (the "Initial Public Offering"). The number of shares of Common Stock set forth in Table I gives effect to the Stock Split (as defined below), which resulted in HWF II's beneficial ownership of Common Stock increasing from 97,561 shares to 169,756 shares. |
(3) | The number of underlying shares of Common Stock reported in Column 3 of Table II reflects and gives effect to a 1.74-for-1 stock split (the "Stock Split"), to be made effective immediately prior to the closing of the Initial Public Offering. |
(4) | The Issuer's Series A Preferred Stock, par value $0.01 (the "Series A Preferred Stock"), is convertible at any time, at the holder's election, on a one-for-one basis (subject to adjustments for anti-dilution) for Common Stock, and has no expiration date. In addition, the Series A Preferred Stock will automatically convert into Common Stock upon the closing of an initial public offering meeting certain specified conditions, and it will also convert into Common Stock in the event holders of at least 75% of the Series A Preferred Stock approve a mandatory conversion. |
(5) | These securities are directly held by GPG LPI Investment, LLC ("GPG LPI"). Carl D. Soderstrom and Clay M. Heighten, M.D. are the managing members of GPG, which is the managing member GPG LPI. Therefore, Carl D. Soderstrom, Clay M. Heighten, M.D., and GPG may be deemed to beneficially own these securities. |
(6) | These securities are directly held by Lantern 3-19 Investment, LLC ("Lantern 3-19"). Carl D. Soderstrom, Clay M. Heighten, M.D., and Gilbert G. Garcia II are the managing members of Green Park & Golf Ventures II, LLC ("GPG II"), which is the managing member Lantern 3-19. Therefore, Carl D. Soderstrom, Clay M. Heighten, M.D., Gilbert G. Garcia II, and GPG II may be deemed to beneficially own these securities. |
(7) | The Series A Preferred Stock Warrant is exercisable at any time, at the holder's election, up to and until the Expiration Date (as defined below). |
(8) | Each Series A Preferred Stock Warrant will expire and no longer be exercisable upon the earliest to occur of (a) 5:00 PM (pacific time) on the fifth anniversary of the date of issuance of such Series A Preferred Stock Warrant and (b) the consummation of a Change of Control (as such term is set forth in the Form of Preferred Stock Warrant filed with the SEC on April 16, 2020, as subsequently amended by that certain Form of Amendment to Preferred Stock Warrant filed with the SEC on May 19, 2020) (collectively, the "Expiration Date"). |
Remarks: (9) Signed by Gilbert G. Garcia II in his capacity as Principal of Green Park & Golf Ventures, LLC, the managing member of GPG LPI Investment, LLC. (10) Signed by Gilbert G. Garcia II in his capacity as Manager of Green Park & Golf Ventures II, LLC, the managing member of Lantern 3-19 Investment, LLC. (11) Signed by Gilbert G. Garcia II in his capacity as Principal of Green Park & Golf Ventures, LLC, the managing member of Health Wildcatters, LLC, the managing member of Health Wildcatters Fund II, LLC. (12) Signed by Gilbert G. Garcia II in his capacity as Principal of Green Park & Golf Ventures, LLC, the managing member of Health Wildcatters, LLC. (13) Signed by Gilbert G. Garcia II in his capacity as Manager of Green Park & Golf Ventures II, LLC. (14) Signed by Gilbert G. Garcia II in his capacity as Principal of Green Park & Golf Ventures, LLC. |