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 | ||||
Stock Options | (2) | (2) | Common Stock | 32,538 (1) (2) | $ 1.03 (1) | D | |
Series A Preferred Stock | (3) | (3) | Common Stock | 31,927 (1) (3) | $ (1) (3) | D | |
Series A Warrants | 05/25/2019 | 07/25/2024 | Common Stock | 3,831 (1) (4) | $ 3.13 (1) (4) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
KEYSER D JEFFREY C/O LANTERN PHARMA INC. 1920 MCKINNEY AVENUE, 7TH FLOOR DALLAS,, TX 75201 |
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/s/ Donald Jeffrey Keyser | 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) | In connection with the Issuer's initial public offering ("IPO"), the Issuer intends to effect a 1.74-for-1 stock split on its outstanding common stock, which will become effective immediately prior to the closing of the Issuer's IPO ("Stock Split"). The share amounts and the price reflect the anticipated Stock Split. |
(2) | The securities beneficially owned by the Reporting Person consists of 32,538 shares of common stock subject to options exercisable within 60 days. |
(3) | The securities beneficially owned by the Reporting Person consists of 18,349 shares of Series A Preferred Stock, which will automatically convert into 31,927 shares of common stock immediately prior to the closing of the Issuer's IPO. |
(4) | The securities beneficially owned by the Reporting Person consists of warrants to purchase up to 2,202 shares of the Issuer's Series A Preferred Stock; provided, that upon the closing of the Issuer's IPO, such warrants will be amended to represent a right to purchase up to 3,831 shares of common stock at $3.13 per share. |