Statement of Changes in Beneficial Ownership (4)
April 04 2016 - 5:32PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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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1. Name and Address of Reporting Person
*
Margolis Jeff Eliot
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2. Issuer Name
and
Ticker or Trading Symbol
RespireRx Pharmaceuticals Inc.
[
RSPI
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
VP, Treasurer & Secretary
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(Last)
(First)
(Middle)
C/O RESPIRERX PHARMACEUTCALS INC., 126 VALLEY ROAD, SUITE C
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3. Date of Earliest Transaction
(MM/DD/YYYY)
8/28/2015
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(Street)
GLEN ROCK, NJ 07452
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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9/14/2015
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X
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507374
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A
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(1)
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15618816
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D
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Common Stock
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9/14/2015
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S
(1)
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483872
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D
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(1)
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15134944
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Warrants (right to buy)
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$0.021
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8/28/2015
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J
(2)
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325022
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(2)
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9/30/2020
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Common Stock
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325022
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$0
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325022
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D
(4)
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Warrants (right to buy)
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$0.035
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9/14/2015
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X
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507374
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(1)
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9/15/2015
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Common Stock
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507374
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(1)
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0
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D
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Warrants (right to buy)
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$0.021
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9/28/2015
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J
(2)
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309975
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(2)
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9/30/2020
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Common Stock
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309975
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$0
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634997
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D
(4)
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Warrants (right to buy)
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$0.021
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11/2/2015
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J
(2)
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939729
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(2)
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9/30/2020
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Common Stock
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939729
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$0
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1574726
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D
(4)
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Common Stock Options (to purchase shares of Common Stock)
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$0.0227
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3/31/2016
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A
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24000000
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(3)
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3/31/2021
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Common Stock
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24000000
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$0
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24000000
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D
(4)
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Common Stock Options (to purchase shares of Common Stock)
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$0.0197
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(5)
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8/18/2022
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Common Stock
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10000000
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10000000
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D
(4)
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Common Stock Options (to purchase shares of Common Stock)
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$0.025
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(6)
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6/30/2022
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Common Stock
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15000000
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15000000
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D
(4)
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Common Stock Options (to purchase shares of Common Stock)
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$0.05
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(7)
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7/17/2019
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Common Stock
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5000000
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5000000
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D
(8)
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Explanation of Responses:
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(
1)
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On September 14, 2015, the reporting person exercised warrants to purchase 507,374 shares of the registrant's common stock for $0.035 per share. The reporting person paid the exercise price on a cashless basis, resulting in the registrant withholding 483,872 of the warrant shares to pay the exercise price and issuing the reporting person the remaining 23,502 shares. These Warrants were acquired by Mr. Margolis in his capacity as President of Aurora Capital LLC, which served as placement agent in the Company's convertible note and warrant offering, and represent his share of the Placement Agent Warrants awarded in that transaction at each closing. The Warrants were exercisable on September 14, 2015.
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(
2)
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These Warrants were acquired by Mr. Margolis in his capacity as President of Aurora Capital LLC, which served as placement agent in the Company's unit offering with each unit consisting of one share of common stock and warrants to purchase two additional shares of common stock, and represent his share of the Placement Agent Warrants awarded at each closing of that transaction. The warrants are currently exercisable.
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(
3)
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These Common Stock Options vest in four equal installments: 25 percent on March 31, 2016 (the grant date), 25 percent on June 30, 2016, 25 percent on September 30, 2016, and 25 percent on December 31, 2016.
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(
4)
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Mr. Margolis holds these securities jointly with his spouse.
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(
5)
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These Common Stock Options vest in four equal installments: 25 percent on December 31, 2015, 25 percent on March 31, 2016, 25 percent on June 30, 2016, and 25 percent on September 30, 2016.
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(
6)
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These Common Stock Options vested in three installments: 50 percent on June 30, 2015, 25 percent on September 30, 2015, and 25 percent on December 31, 2015.
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(
7)
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These Common Stock Options vested in three equal installments on July 17, 2014, September 30, 2014 and December 31, 2014, and are all currently vested and exercisable.
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(
8)
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Mr. Margolis holds 2,727,273 of these securities jointly with his spouse.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Margolis Jeff Eliot
C/O RESPIRERX PHARMACEUTCALS INC.
126 VALLEY ROAD, SUITE C
GLEN ROCK, NJ 07452
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X
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VP, Treasurer & Secretary
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Signatures
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/s/ Jeff Eliot Margolis
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4/4/2016
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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