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) 07/26/2018 | 3. Issuer Name and Ticker or Trading Symbol PROLUNG INC [ LUNG ] | |||||||||||||
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, par value $.001 per share(1) | 174,251 | D(2) | |
Common Stock, par value $.001 per share(1) | 0 | D(3) | |
Common Stock, par value $.001 per share(1) | 0 | D(4) | |
Common Stock, par value $.001 per share(1) | 27,188 | D(5) | |
Common Stock, par value $.001 per share(1) | 32,500 | I | By: Todd M. Morgan Living Trust(5) |
Common Stock, par value $.001 per share(1) | 33,750 | I | By: Creekside Investments(5) |
Common Stock, par value $.001 per share(1) | 3,750 | I | By: E&M Morgan, LLC(5) |
Common Stock, par value $.001 per share(1) | 50,000 | I | By: MPM Investments LP(5) |
Common Stock, par value $.001 per share(1) | 25,000 | I | By: T&L Business Ventures(5) |
Common Stock, par value $.001 per share(1) | 277,621 | D(6) | |
Common Stock, par value $.001 per share(1) | 39,683 | D(7) | |
Common Stock, par value $.001 per share(1) | 8,900 | D(8) | |
Common Stock, par value $.001 per share(1) | 58,735 | D(9) |
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 |
Explanation of Responses: |
1. This Form 3 is filed jointly by Steven C. Eror, Richard Serbin, Michael N. Christiansen, Todd M. Morgan, ErIc M. Sokol, Ron Dunford, Brian W. Loveridge, and Don A. Patterson (each a "Reporting Person" and collectively the "Reporting Persons"). Each of the Reporting Persons is a member of a Section 13(d) group that collectively owns more than 10% of the Issuer's outstanding shares of Common Stock. Each of the Reporting Persons disclaims beneficial ownership of the securities reported herein except to the extent of his pecuniary interest therein. |
2. Represents shares owned directly by Mr. Eror. |
3. Represents shares owned directly by Richard Serbin. |
4. Represents shares owned directly by Michael N. Christiansen. |
5. Represents shares owned beneficially by Todd M. Morgan. Mr. Morgan may be deemed to be the beneficial owner of the shares owned directly by the Todd M. Morgan Living Trust, of which Mr. Morgan serves as Trustee. Mr. Morgan may be deemed to be the beneficial owner of the shares owned directly by Creekside Investments, E&M Morgan, LLC, and T&L Business Ventures, each of which Mr. Morgan serves as the Manager. Mr. Morgan may be deemed to be the beneficial owner of the shares owned directly by MPM Investments, LP, of which Mr. Morgan is general partner and Manager. |
6. Represents shares owned directly by Eric M. Sokol, including shares issuable upon the conversion of certain convertible notes. |
7. Represents shares owned directly by Ron Dunford, including shares issuable upon the conversion of certain convertible notes. |
8. Represents shares owned by Brian W. Loveridge. |
9. Represents shares owned by Don A. Patterson, including shares issuable upon the conversion of certain convertible notes. |
/s/ Steven C. Eror | 08/07/2018 | |
/s/ Steven C. Eror as attorney-in-fact for Richard Serbin | 08/07/2018 | |
/s/ Steven C. Eror as attorney-in-fact for Michael N. Christiansen | 08/07/2018 | |
/s/ Steven C. Eror as attorney-in-fact for Todd M. Morgan | 08/07/2018 | |
/s/ Steven C. Eror as attorney-in-fact for Eric M. Sokol | 08/07/2018 | |
/s/ Steven C. Eror as attorney-in-fact for Ron Dunford | 08/07/2018 | |
/s/ Steven C. Eror as attorney-in-fact for Brian W. Loveridge | 08/07/2018 | |
/s/ Steven C. Eror as attorney-in-fact for Don A. Patterson | 08/07/2018 | |
** 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. |