Keyser D Jeffrey Form 3 Lantern Pharma / D JEFFREY KEYSER ownership change

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^*

KEYSER D JEFFREY

(Last) (First) (Middle)

C/O LANTERN PHARMA INC.

1920 MCKINNEY AVENUE, 7TH FLOOR

(Street)

DALLAS, TX 75201

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
06/10/2020

3. Issuer Name and Ticker or Trading Symbol
Lantern Pharma Inc. [ LTRN ]

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)

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
Stock Options	(2)	(2)	Common Stock	32,538(1)(2)	1.03(1)	D
Series A Preferred Stock	(3)	(3)	Common Stock	31,927(1)(3)	(1)(3)	D
Series A Warrants	05/25/2019	07/25/2024	Common Stock	3,831(1)(4)	3.13(1)(4)	D

Explanation of Responses:

1. In connection with the Issuer's initial public offering ("IPO"), the Issuer intends to effect a 1.74-for-1 stock split on its outstanding common stock, which will become effective immediately prior to the closing of the Issuer's IPO ("Stock Split"). The share amounts and the price reflect the anticipated Stock Split.

2. The securities beneficially owned by the Reporting Person consists of 32,538 shares of common stock subject to options exercisable within 60 days.

3. The securities beneficially owned by the Reporting Person consists of 18,349 shares of Series A Preferred Stock, which will automatically convert into 31,927 shares of common stock immediately prior to the closing of the Issuer's IPO.

4. The securities beneficially owned by the Reporting Person consists of warrants to purchase up to 2,202 shares of the Issuer's Series A Preferred Stock; provided, that upon the closing of the Issuer's IPO, such warrants will be amended to represent a right to purchase up to 3,831 shares of common stock at $3.13 per share.

	/s/ Donald Jeffrey Keyser	06/10/2020
	** 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).
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