(1) Consists of shares held by the Riley McCormack Revocable Trust, of which the reporting person is trustee.
(2) Based on 21,150,486 shares of Common Stock issued and outstanding per ARCA biopharma, Inc. Form 10-Q
dated November 12, 2014.
(Page 2 of 5 Pages)
Item 1(a). Name of Issuer:
ARCA biopharma, Inc.
Item 1(b). Address of Issuer's principal executive offices:
11080 CirclePoint Road, Suite 140
Westminster, Colorado
Item 2(a). Name of persons filing:
RILEY McCORMACK
Item 2(b). Address or principal business office or, if none, residence:
2515 Alhambra Circle
Coral Gables, Florida 33134
Item 2(c). Citizenship or Place of Organization:
USA
Item 2(d). Title of class of securities:
Common Stock
Item 2(e). CUSIP No. 00211Y100
Item 3. If this statement is filed pursuant to Rules 13d-1(b), or 13d-2(b) or (c), check whether the person is filing is a:
(a) ¨
Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o).
(b) ¨
Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c).
(c) ¨
Insurance company as defined in section 3(a)(19) of the Act (15 U.S. C. 78c).
(d) ¨
Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C. 80a-8)
(e) ¨
An investment adviser in accordance with § 240.13d-1(b)(1)(ii)(E);
(f) ¨
An employee benefit plan or endowment fund in accordance with § 240.13d-1(b)(1)(ii)(F);
(g) ¨
A parent holding company or control person in accordance with § 240.13d-1(b)(1)(ii)(G);
(h) ¨
A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813);
(i) ¨
A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940 915 U.S.C. 80a-3);
(j) ¨
Group, in accordance with § 240.13d-1(b)(1)(ii)(J).
NOT APPLICABLE
(Page 3 of 5 Pages)
Item 4. Ownership
(a) Amount beneficially owned: 3,000,000
(b) Percent of class: 14.18%
(c) Number of shares as to which the person has:
(i) Sole power to vote or to direct the vote: 3,000,000
(ii) Shared power to vote or to direct the vote: 0
(iii) Sole power to dispose or to direct the disposition of: 3,000,000
(iv) Shared power to dispose or to direct the disposition of: 0
Item 5. Ownership of Five Percent or Less of a Class
If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial
owner of more than five percent of the class of securities, check the following ¨
Item 6. Ownership of More than Five Percent on Behalf of Another Person
NOT APPLICABLE
Item 7. Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding
Company
NOT APPLICABLE
Item 8. Identification and Classification of Members of the Group
NOT APPLICABLE
Item 9. Notice of Dissolution of the Group
NOT APPLICABLE
Item 10. Certification
By signing below, I certify that, to the best of my knowledge and belief, the securities referred to
above were not acquired and are not held for the purpose of or with the effective of changing or
influencing the control of the issuer of the securities and were not acquired and are not held in
connection with or as a participant in any transaction having that purpose or effect.
EXHIBITS
None
(Page 4 of 5 Pages)
SIGNATURES
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: January 5, 2015
By: /s/ Riley McCormack
Name/Title: Riley McCormack, Trustee
(Page 5 of 5 Pages)
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