X0508 4 2023-08-02 0001904286 MIRA PHARMACEUTICALS, INC. MIRA 0001986372 Cappy George C/O MIRA PHARMACEUTICALS, INC. 900 WEST PLATT STREET, SUITE 200 TAMPA FL 33606-2173 true 0001986593 Bay Shore Trust C/O MIRA PHARMACEUTICALS, INC. 900 WEST PLATT STREET, SUITE 200 TAMPA FL 33606-2173 true false Common Stock 2023-08-02 4 P 0 157170 7 A 2740270 I By Trust Common Stock 20000 D Common Stock Warrant (right to buy) 5 2023-04-28 2028-04-28 Common Stock 1000000 1000000 I By Trust Represents the acquisition of shares of common stock by the Bay Shore Trust (the "Trust") through the conversion of an aggregate of $1,100,190 of indebtedness owing by the Issuer to the Trust, with such conversion occurring on the date of the Issuer's initial public offering at a conversion price of $7.00 per share. These securities are owned directly by the Trust, a greater-than-10% owner of the Issuer. As sole trustee of the Trust, George Cappy ("Mr. Cappy") has sole ownership and dispositive power over these securities and is therefore deemed to be an indirect beneficial owner of the securities for purposes of SEC Rule 13d-3, although Mr. Cappy disclaims beneficial ownership of the reported securities due to the absence of any pecuniary interest therein. These securities are owned directly by Mr. Cappy. /s/ Michelle Yanez, Attorney-in-Fact for George Cappy 2023-08-04 /s/ Michelle Yanez, Attorney-in-Fact for George Cappy, Trustee 2023-08-04