Initial Statement of Beneficial Ownership (3)
December 19 2018 - 5:13PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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
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Burns John Thomas
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2. Date of Event Requiring Statement (MM/DD/YYYY)
12/17/2018
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3. Issuer Name
and
Ticker or Trading Symbol
SELLAS Life Sciences Group, Inc. [SLS]
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(Last)
(First)
(Middle)
C/O SELLAS LIFE SCIENCES GROUP, INC., 15 W. 38TH STREET, 10TH FLOOR
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
VP, Finance & Corp Controller /
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(Street)
NEW YORK, NY 10018
(City)
(State)
(Zip)
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5. 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 Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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18
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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. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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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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Stock Option (Right to Buy)
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(1)
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6/28/2023
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Common Stock
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33
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$1332.00
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D
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Stock Option (Right to Buy)
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(1)
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11/26/2023
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Common Stock
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42
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$2328.00
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D
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Stock Option (Right to Buy)
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(1)
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1/15/2025
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Common Stock
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25
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$1050.00
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D
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Stock Option (Right to Buy)
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(1)
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6/19/2025
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Common Stock
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33
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$1062.00
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D
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Stock Option (Right to Buy)
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(1)
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12/18/2025
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Common Stock
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50
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$900.00
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D
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Stock Option (Right to Buy)
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(1)
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2/23/2026
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Common Stock
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125
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$504.00
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D
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Stock Option (Right to Buy)
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(1)
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1/17/2027
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Common Stock
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500
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$54.30
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D
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Stock Option (Right to Buy)
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(2)
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3/13/2028
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Common Stock
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20000
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$5.24
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D
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Explanation of Responses:
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(1)
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Fully vested and immediately exercisable.
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(2)
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One-quarter (1/4) of the option shares will vest and became exercisable one year from the March 13, 2018 grant date, and the remainder will vest and become exercisable in equal monthly installments for thirty-six (36) months thereafter, provided that the Reporting Person remains in service with the Issuer through each such monthly vesting date.
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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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Burns John Thomas
C/O SELLAS LIFE SCIENCES GROUP, INC.
15 W. 38TH STREET, 10TH FLOOR
NEW YORK, NY 10018
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VP, Finance & Corp Controller
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Signatures
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/s/ John Burns
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12/19/2018
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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 5(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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