0001213900-20-014619.txt : 20200610 0001213900-20-014619.hdr.sgml : 20200610 20200610174129 ACCESSION NUMBER: 0001213900-20-014619 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200610 FILED AS OF DATE: 20200610 DATE AS OF CHANGE: 20200610 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KEYSER D JEFFREY CENTRAL INDEX KEY: 0001393516 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39318 FILM NUMBER: 20955600 MAIL ADDRESS: STREET 1: 4848 LOOP CENTRAL DRIVE STREET 2: SUITE 700 CITY: HOUSTON STATE: TX ZIP: 77081 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Lantern Pharma Inc. CENTRAL INDEX KEY: 0001763950 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 463973463 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1920 MCKINNEY AVENUE STREET 2: 7TH FLOOR CITY: DALLAS STATE: TX ZIP: 75201 BUSINESS PHONE: 972-277-1136 MAIL ADDRESS: STREET 1: 1920 MCKINNEY AVENUE STREET 2: 7TH FLOOR CITY: DALLAS STATE: TX ZIP: 75201 FORMER COMPANY: FORMER CONFORMED NAME: Lantern Pharma DATE OF NAME CHANGE: 20190108 3 1 ownership.xml OWNERSHIP DOCUMENT X0206 3 2020-06-10 0 0001763950 Lantern Pharma Inc. LTRN 0001393516 KEYSER D JEFFREY C/O LANTERN PHARMA INC. 1920 MCKINNEY AVENUE, 7TH FLOOR DALLAS, TX 75201 1 0 0 0 Stock Options 1.03 Common Stock 32538 D Series A Preferred Stock Common Stock 31927 D Series A Warrants 3.13 2019-05-25 2024-07-25 Common Stock 3831 D In connection with the Issuer's initial public offering ("IPO"), the Issuer intends to effect a 1.74-for-1 stock split on its outstanding common stock, which will become effective immediately prior to the closing of the Issuer's IPO ("Stock Split"). The share amounts and the price reflect the anticipated Stock Split. The securities beneficially owned by the Reporting Person consists of 32,538 shares of common stock subject to options exercisable within 60 days. The securities beneficially owned by the Reporting Person consists of 18,349 shares of Series A Preferred Stock, which will automatically convert into 31,927 shares of common stock immediately prior to the closing of the Issuer's IPO. The securities beneficially owned by the Reporting Person consists of warrants to purchase up to 2,202 shares of the Issuer's Series A Preferred Stock; provided, that upon the closing of the Issuer's IPO, such warrants will be amended to represent a right to purchase up to 3,831 shares of common stock at $3.13 per share. /s/ Donald Jeffrey Keyser 2020-06-10