Statement of Changes in Beneficial Ownership (4)
June 17 2020 - 5:36PM
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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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
*
Green Park & Golf Ventures II, LLC |
2. Issuer Name and Ticker or Trading Symbol
Lantern Pharma Inc.
[
LTRN
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director __X__ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
5910 N. CENTRAL EXPY, SUITE 1400 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/15/2020 |
(Street)
DALLAS, TX 75206
(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)
___ Form filed by One Reporting Person
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X
_ 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, par value $0.0001 | 6/15/2020 | | C | | 41535 (4) | A | (5) | 211291 | I | See footnote (1) |
Common Stock, par value $0.0001 | 6/15/2020 | | C | | 292605 (4) | A | (6) | 292605 | I | See footnote (2) |
Common Stock, par value $0.0001 | 6/15/2020 | | C | | 131697 (4) | A | (7) | 131697 | I | See footnote (3) |
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) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 7. Title and Amount of Securities Underlying Derivative Security (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) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Series A Preferred Stock, par value $0.01 | (5) | 6/15/2020 | | C | | | 23871 | (5) | (5) | Common Stock | 41535 (4) | (5) | 0 | I | See footnote (1) |
Series A Preferred Stock, par value $0.01 | (6) | 6/15/2020 | | C | | | 168164 | (6) | (6) | Common Stock | 292605 (4) | (6) | 0 | I | See footnote (2) |
Series A Preferred Stock, par value $0.01 | (7) | 6/16/2020 | | C | | | 75688 | (7) | (7) | Common Stock | 131697 (4) | (7) | 0 | I | See footnote (3) |
Explanation of Responses: |
(1) | These securities are directly held by Health Wildcatters Fund II, LLC ("HWF II"). Carl D. Soderstrom and Clay M. Heighten, M.D. are the managing members of Green Park & Golf Ventures, LLC ("GPG"), which is the managing member of Health Wildcatters, LLC ("HW"), which is the managing member of HWF II. Therefore, Carl D. Soderstrom, Clay M. Heighten, M.D., GPG, and HW may be deemed to beneficially own these securities. |
(2) | These securities are directly held by GPG LPI Investment, LLC ("GPG LPI"). Carl D. Soderstrom and Clay M. Heighten, M.D. are the managing members of GPG, which is the managing member GPG LPI. Therefore, Carl D. Soderstrom, Clay M. Heighten, M.D., and GPG may be deemed to beneficially own these securities. |
(3) | These securities are directly held by Lantern 3-19 Investment, LLC ("Lantern 3-19"). Carl D. Soderstrom, Clay M. Heighten, M.D., and Gilbert G. Garcia II are the managing members of Green Park & Golf Ventures II, LLC ("GPG II"), which is the managing member Lantern 3-19. Therefore, Carl D. Soderstrom, Clay M. Heighten, M.D., Gilbert G. Garcia II, and GPG II may be deemed to beneficially own these securities. |
(4) | In connection with the Issuer's initial public offering, which commenced on June 10, 2020 and closed on June 15, 2020 (the "Initial Public Offering"), the Issuer effected a 1.74-for-1 stock split on its outstanding common stock, par value $0.0001 (the "Common Stock"), which was made effective immediately prior to the closing of the Issuer's Initial Public Offering (the "Stock Split"). The share amounts set forth in this column reflect the Stock Split. |
(5) | In connection with the Initial Public Offering, 23,871 shares of the Issuer's Series A Preferred Stock, par value $0.01 ("Series A Preferred Stock"), directly held by HWF II, which had no expiration date, were automatically converted into 41,535 shares of Common Stock for no additional consideration immediately prior to the closing of the Initial Public Offering. |
(6) | In connection with the Initial Public Offering, 168,164 shares of Series A Preferred Stock directly held by GPG LPI, which had no expiration date, were automatically converted into 292,605 shares of Common Stock for no additional consideration immediately prior to the closing of the Initial Public Offering. |
(7) | In connection with the Initial Public Offering, approximately 75,688 shares of Series A Preferred Stock directly held by Lantern 3-19, which had no expiration date, were automatically converted into 131,697 shares of Common Stock for no additional consideration immediately prior to the closing of the Initial Public Offering. |
Remarks: (8) Signed by Gilbert G. Garcia II in his capacity as Principal of Green Park & Golf Ventures, LLC, the managing member of GPG LPI Investment, LLC.
(9) Signed by Gilbert G. Garcia II in his capacity as Manager of Green Park & Golf Ventures II, LLC, the managing member of Lantern 3-19 Investment, LLC.
(10) Signed by Gilbert G. Garcia II in his capacity as Principal of Green Park & Golf Ventures, LLC, the managing member of Health Wildcatters, LLC, the managing member of Health Wildcatters Fund II, LLC.
(11) Signed by Gilbert G. Garcia II in his capacity as Principal of Green Park & Golf Ventures, LLC, the managing member of Health Wildcatters, LLC.
(12) Signed by Gilbert G. Garcia II in his capacity as Manager of Green Park & Golf Ventures II, LLC.
(13) Signed by Gilbert G. Garcia II in his capacity as Principal of Green Park & Golf Ventures, LLC. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Green Park & Golf Ventures II, LLC 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
| X |
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GPG LPI Investment, LLC 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
| X |
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Lantern 3-19 Investment, LLC 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
| X |
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Health Wildcatters Fund II, LLC 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
| X |
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Health Wildcatters, LLC 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
| X |
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Green Park & Golf Ventures, LLC 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
| X |
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Garcia Gilbert G. II 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
| X |
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Heighten Clay M 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
| X |
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Soderstrom Carl D 5910 N. CENTRAL EXPY, SUITE 1400 DALLAS, TX 75206 |
| X |
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Signatures
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/s/ Gilbert G. Garcia II (8) | | 6/17/2020 |
**Signature of Reporting Person | Date |
/s/ Gilbert G. Garcia II (9) | | 6/17/2020 |
**Signature of Reporting Person | Date |
/s/ Gilbert G. Garcia II (10) | | 6/17/2020 |
**Signature of Reporting Person | Date |
/s/ Gilbert G. Garcia II (11) | | 6/17/2020 |
**Signature of Reporting Person | Date |
/s/ Gilbert G. Garcia II (12) | | 6/17/2020 |
**Signature of Reporting Person | Date |
/s/ Gilbert G. Garcia II (13) | | 6/17/2020 |
**Signature of Reporting Person | Date |
/s/ Gilbert G. Garcia II | | 6/17/2020 |
**Signature of Reporting Person | Date |
/s/ Clay M. Heighten M.D. | | 6/17/2020 |
**Signature of Reporting Person | Date |
/s/ Carl D. Soderstrom | | 6/17/2020 |
**Signature of Reporting Person | Date |
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