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) 12/15/2020 | 3. Issuer Name and Ticker or Trading Symbol Scopus BioPharma Inc. [ SCPS ] | |||||||||||||
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 $0.001 | 2,000(1) | D | |
Common Stock, par value $0.001 | 210,052(2) | I | Dayber Snow LLC |
Common Stock, par value $0.001 | 200,000(3) | I | HCFP/Capital Partners 18B-1 LLC |
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 | ||||
W Warrant(4) | 10/01/2021 | 09/30/2026 | B Unit | 6,668(5) | 4 | I | Dayber Snow LLC |
W Warrant(4) | 10/01/2021 | 09/30/2026 | B Unit | 769,500(5) | 4 | I | HCFP/Capital Partners 18B-2 LLC |
Explanation of Responses: |
1. Includes an aggregate of 2,000 shares held by Mr. Gibson's minor children. |
2. Includes shares held by Dayber Snow LLC, of which Mr. Gibson is a member and co-manager. Accordingly, he is deemed to have shared voting and dispositive power over the shares held by this entity. |
3. Does not have voting or dispositive power over the shares held by this entity. Mr. Gibson disclaims beneficial ownership of shares held by this entity, except to the extent of his proportionate pecuniary interest therein. |
4. Each W Warrant is exercisable for one B Unit. Starting on April 1, 2022, each B Unit can be separated into one share of common stock and one Z Warrant. Each Z warrant is exercisable for one share of common stock with an exercise price of $5.00 per share. The Z Warrant will become exercisable on July 1, 2022 and will expire on June 30, 2027. |
5. Includes securities held by Dayber Snow LLC, of which Mr. Gibson is a member and co-manager, and HCFP/Capital Partners 18B-2 LLC, over which securities Mr. Gibson does not have voting or dispositive power. Accordingly, he is deemed to have shared voting and dispositive power and no voting and dispositive power over the securities held by Dayber Snow LLC and HCFP/Capital Partners 18B-2 LLC, respectively. Mr. Gibson disclaims beneficial ownership of securities held by these entities, except to the extent of his proportionate pecuniary interest therein. |
/s/ Robert J. Gibson | 12/15/2020 | |
** 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). | ||
** 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. |