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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Schneeberger Daniel C/O ANEBULO PHARMACEUTICALS, INC. 1415 RANCH ROAD 620 SOUTH, SUITE 201 LAKEWAY, TX 78734 |
Chief Executive Officer |
/s/ Rex Merchant, as Attorney-in-Fact | 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) | Consists of 245,622 shares of restricted common stock issued pursuant to the terms of Dr. Schneeberger's employment agreement with Anebulo Pharmaceuticals, Inc., which vest in equal quarterly installments from August 1, 2020 to November 1, 2021. In addition, includes additional shares of restricted common stock which vest upon achieving certain performance targets as follows: (i) 245,622 shares upon the first patient being dosed in a Phase 2 clinical trial with ANEB-001 and (ii) 245,622 shares upon the availability of a newly synthesized active pharmaceutical ingredient acceptable for dosing in a U.S. clinical trial. Dr. Schneeberger also reflects 245,634 shares that vest upon completion of Anebulo Pharmaceuticals, Inc.'s initial public offering. |
Remarks: Exhibit List: Exhibit 24 - Power of Attorney |