3: Initial statement of beneficial ownership of securities
Published on January 15, 2021
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 | ||||
Options to purchase common stock (1) | 01/11/2021 | 01/11/2031 | Common Stock | 100,000 | $ 2.01 | D | |
Warrants to purchase common stock (2) | 01/08/2021 | 01/08/2026 | Common Stock | 67,500 | $ 1.5 | D | |
Convertible Note (3) | 01/08/2021 | 01/08/2023 | Common Stock | 50,000 | $ 1 | D |
Reporting Owners
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Freedman Joseph David 945 SOUTHSIDE PLACE NASHVILLE, TN 37203 |
X |
Signatures
/s/ Joseph David Freedman | 01/11/2021 | |
**Signature of Reporting Person | Date |
Explanation of Responses:
* | 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) | Includes options to purchase a total of 100,000 shares of common stock. 50,000 options are vested immediately, with an additional 25,000 options vesting on each of the first and second anniversary of the grant date. under the 2019 Equity Incentive Plan |
(2) | Warrant is exercisable at a price of $1.50 per share for a period of 5 years. In the event of a "Qualified Offering," as defined in the Warrant, the exercise price will be the lower of $1.50 per share or a 25% discount to the offering price per share in the Qualified Offering. |
(3) | Note is convertible to common stock at a price of $1.00 per share, and matures in 2 years. In the event of a "Qualified Offering," as defined in the Note, the conversion price will be the lower of $1.00 per share or a 25% discount to the offering price per share in the Qualified Offering. |