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*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 11/15/2018 | 3. Issuer Name and Ticker or Trading Symbol Vitality Biopharma, Inc. [ VBIO ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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 | 602,876(1) | D | |
Common Stock | 217,624 | I | By The Feighan Family Fund LLC(2) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 | ||||
Common Stock Warrants (right to buy) | 10/22/2018 | 10/22/2023 | Common Stock | 502,500(3) | 3 | D | |
Common Stock Warrants (right to buy) | 10/22/2018 | 10/22/2023 | Common Stock | 167,500 | 3 | I | By the Feighan Family Fund LLC(4) |
Explanation of Responses: |
1. In connection with a Securities Purchase Agreement dated October 19, 2018, Mr. Feighan acquired 502,500 shares of the Company's common stock. In connection with a Share Exchange Agreement dated October 19, 2018, Mr. Feighan acquired 100,376 shares of the Company's common stock. |
2. In connection with a Securities Purchase Agreement dated October 19, 2018, The Feighan Family Fund LLC, an entity beneficially owned by Mr. Feighan (the "LLC") acquired 167,500 shares of the Company's common stock. In connection with a Share Exchange Agreement dated October 19, 2018, the LLC acquired 50,124 shares of the Company's common stock. Mr. Feighan may be deemed to indirectly beneficially own common stock held directly by the LLC and disclaims beneficial ownership of all such common stock. |
3. In connection with a Securities Purchase Agreement dated October 19, 2018, Mr. Feighan received a warrant to purchase 502,500 shares of the Company's common stock. |
4. In connection with a Securities Purchase Agreement dated October 19, 2018, The Feighan Family Fund LLC, an entity beneficially owned by Mr.Feighan (the "LLC") received a warrant to purchase 167,500 shares of the Company's common stock. Mr. Feighan may be deemed to indirectly beneficially own common stock held directly by the LLC and disclaims beneficial ownership of all such common stock. |
/s/ Edward F. Feighan | 11/21/2018 | |
** 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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |