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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 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 (Month/Day/Year) |
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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series A Preferred Stock | (2) | 06/15/2020 | C | 18,349 | (2) | (2) | Common Stock | 31,927 (1) (2) | (2) | 0 | D | ||||
Stock Option | $ 15 (3) | 06/15/2020 | A | 9,135 | (3) | (3) | Common Stock | 9,135 | (3) | 9,135 | 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 | 06/15/2020 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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 effected a 1.74-for-1 stock split on its outstanding common stock, which became effective immediately prior to the closing of the Issuer's IPO ("Stock Split"). The share amounts reflect the Stock Split. |
(2) | In connection with the IPO, the 18,349 shares of Series A Preferred Stock held by the Reporting Person were automatically converted for no additional consideration into 31,927 shares of common stock immediately prior to the closing of the Issuer's IPO. |
(3) | The Reporting Person was granted options to purchase 9,135 shares of the Issuer's common stock at the exercise price equal to the price per share sold in the Issuer's IPO. The options granted will vest in equal monthly increments over a 36 month period commencing upon the closing of the Issuer's IPO, which is the grant date of the options. Under the Amended and Restated 2018 Equity Incentive Plan, the options may not be exercised after the tenth anniversary of the grant date. |