0001213900-23-056875.txt : 20230713 0001213900-23-056875.hdr.sgml : 20230713 20230713193354 ACCESSION NUMBER: 0001213900-23-056875 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230711 FILED AS OF DATE: 20230713 DATE AS OF CHANGE: 20230713 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jermasek Douglas CENTRAL INDEX KEY: 0001955273 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40582 FILM NUMBER: 231087738 MAIL ADDRESS: STREET 1: 4300 EL CAMINO REAL STREET 2: SUITE 210 CITY: LOS ALTOS STATE: CA ZIP: 94022 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Unicycive Therapeutics, Inc. CENTRAL INDEX KEY: 0001766140 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 813638692 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 4300 EL CAMINO REAL, SUITE 210 CITY: LOS ALTOS STATE: CA ZIP: 94022 BUSINESS PHONE: 650-384-0642 MAIL ADDRESS: STREET 1: 4300 EL CAMINO REAL, SUITE 210 CITY: LOS ALTOS STATE: CA ZIP: 94022 4 1 ownership.xml X0407 4 2023-07-11 0 0001766140 Unicycive Therapeutics, Inc. UNCY 0001955273 Jermasek Douglas C/O UNICYCIVE THERAPEUTICS LOS ALTOS CA 94022 0 1 0 0 EVP of Corporate Strategy 0 Common Stock 2023-07-11 4 M 0 104612 A 175012 D Series A-1 Convertible Preferred Stock 0.49 2023-07-11 4 M 0 50 1000 D Common Stock 0 D Warrant (right to buy 0.54 2023-07-11 4 M 0 79252 A 2023-07-11 Series A-3 Convertible Preferred Stock 79252 79252 D Warrant (right to buy) 0.59 2023-07-11 4 M 0 72047 A 2023-07-11 Series A-4 Convertible Preferred Stock 72047 72047 D Warrant (right to buy) 0.74 2023-07-11 4 M 0 115275 A 2023-07-11 Series A-5 Convertible Preferred Stock 115275 115275 D The reported securities were included within the units issued to the reporting person upon conversion of the Series A-1 Convertible Preferred Stock. The Series A-1 Convertible Preferred Stock converted into units at an exercise price of $0.49 per share. On July 11, 2023, the shares of Series A-1 Convertible Preferred Stock automatically converted into units consisting of (1) 104,612 shares of common stock, (2) a Tranche A Warrant to purchase 79,252 shares of Series A-3 Convertible Preferred Stock, (3) a Tranche B Warrant to purchase 72,047 shares of Series A-4 Convertible Preferred Stock and (4) a Tranche C Warrant to purchase 115,275 shares of Series A-5 Convertible Preferred Stock. The shares of Series A-1 Convertible Preferred Stock had no expiration date prior to conversion. The Tranche A Warrants issued to the reporting person as part of the units issued upon conversion of the Series A-1 Convertible Preferred Stock expire twenty-one (21) days following the Issuer's announcement of receipt of FDA approval for Renazorb. The Tranche B Warrants issued to the reporting person as part of the units issued upon conversion of the Series A-1 Convertible Preferred Stock expire twenty-one (21) days following the Company's announcement of receipt of Transitional Drug Add-On Payment Adjustment approval for Renazorb. The Tranche C Warrants issued to the reporting person as part of the units issued upon conversion of the Series A-1 Convertible Preferred Stock expire twenty-one (21) days following the Company's public disclosure of financial results for four (4) quarters of commercial sales of Renazorb following receipt of Transitional Drug Add-On Payment Adjustment approval for Renazorb, commencing with the first quarter in which the Company receives revenue from Centers for Medicare and Medicaid Services for Renazorb under the Transitional Drug Add-On Payment Adjustment. /s/ Douglas Jermasek 2023-07-13