UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Options to purchase Common Stock | (1) | (1) | Common Stock | 82,290 (2) | $ 2.18 (2) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Lin Kenneth C/O ANEBULO PHARMACEUTICALS, INC. 1415 RANCH ROAD 620 SOUTH, SUITE 201 LAKEWAY, TX 78734 |
X |
/s/ Kenneth Lin | 05/06/2021 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | On March 1, 2021, Mr. Lin received options to purchase 82,290 shares of common stock granted under the Anebulo Pharmaceuticals, Inc. 2020 Stock Incentive Plan. The options are exercisable in four equal annual installments starting on February 1, 2022 and expire on February 28, 2026. |
(2) | Such numbers reflect a 6-for-1 forward stock split. |