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