SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
Adkins William

(Last) (First) (Middle)
C/O SHUTTLE PHARMACEUTICALS HOLDINGS
ONE RESEARCH COURT, SUITE 450

(Street)
ROCKVILLE MD 20850

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/29/2022
3. Issuer Name and Ticker or Trading Symbol
Shuttle Pharmaceuticals Holdings, Inc. [ SHPH ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
COMMON STOCK 280,480(1) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. The undersigned became a Reporting Person subject to Section 16 reporting on August 29, 2022 at the time Shuttle Pharmaceuticals Holdings, Inc ("Company") completed its initial public offering ("IPO"). At the time of the Offering, the Reporting Person was the beneficial owner of 280,480 shares of common stock of the Company, consisting of (i) 138,889 shares of common stock and warrants to purchase 138,889 shares of common stock issuable upon conversion of Series A convertible preferred stock, which stock converts upon close of the Company's IPO, all of which are held by the William Henry Adkins & Pauline Adkins 1993 Revocable Trust, and (ii) 2,702 restricted stock units held by the Reporting Person, all of which have all fully vested as of the date of this report.
/s/ William H. Adkins 09/07/2022
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** 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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