Statement of Changes in Beneficial Ownership (4)
30 Oktober 2015 - 11:10AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
Pollack Kevin
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2. Issuer Name
and
Ticker or Trading Symbol
Lightlake Therapeutics Inc.
[
LLTP
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Chief Financial Officer
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(Last)
(First)
(Middle)
445 PARK AVENUE, 9TH FLOOR
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3. Date of Earliest Transaction
(MM/DD/YYYY)
12/10/2014
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(Street)
NEW YORK, NY 10022
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Options
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$8.00
(1)
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5/1/2013
(2)
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A
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190000
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5/1/2013
(2)
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4/30/2023
(2)
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Common Stock, par value $0.001 per share
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190000
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(3)
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390000
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D
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Options
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$10.00
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5/1/2013
(4)
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A
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165000
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5/1/2013
(4)
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4/30/2023
(4)
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Common Stock, par value $0.001 per share
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165000
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(3)
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555000
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D
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Options
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$15.00
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8/1/2013
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A
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50000
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8/1/2013
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7/31/2023
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Common Stock, par value $0.001 per share
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50000
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(3)
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605000
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D
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Options
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$20.00
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8/1/2013
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A
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50000
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8/1/2013
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7/31/2023
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Common Stock, par value $0.001 per share
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50000
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(3)
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655000
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D
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Options
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$6.00
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12/31/2013
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A
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75000
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12/31/2013
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12/30/2023
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Common Stock, par value $0.001 per share
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75000
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(3)
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730000
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D
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Options
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$5.00
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6/15/2014
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A
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150000
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6/15/2014
(5)
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6/14/2024
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Common Stock, par value $0.001 per share
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150000
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(3)
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880000
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D
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Options
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$8.00
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6/15/2014
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A
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200000
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6/15/2014
(5)
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6/14/2024
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Common Stock, par value $0.001 per share
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200000
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(3)
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1080000
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D
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Options
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$7.25
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10/27/2015
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A
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500000
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10/27/2015
(6)
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10/26/2025
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Common Stock, par value $0.001 per share
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500000
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(4)
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1580000
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D
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Explanation of Responses:
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(
1)
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This Form 4 is a late filing reporting the changes in beneficial ownership of the Reporting Person as of October 29, 2015. This Form 4 was required to be filed within two business days of 12/10/2014, the effective date of the Issuer's Form 8-A registration statement which registered the common stock of the Issuer for the first time under Section 12 of the Exchange Act. The Reporting Person voluntarily filed a Form 3 on December 6, 2012 and a Form 4 on January 3, 2013. In December 2014, the Issuer effected a one-for-one hundred reverse stock split of its common stock (the "1:100 Reverse Stock Split"). Unless otherwise noted, all share amounts and exercise prices listed in this Form 3 been retroactively adjusted for the 1:100 Reverse Stock Split as if such stock splits occurred prior to the issuance of such shares, warrants, or options.
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(
2)
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50,000 vested on 5/1/2013, 50,000 vested on 11/1/2013, and 90,000 vested on 12/31/2013. All expire 10 years after their respective vesting dates.
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(
3)
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Cashless options.
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(
4)
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25,000 vested on 5/1/2013, 25,000 vested on 8/1/2013; 25,000 vested on 11/1/13, and 90,000 vested on 12/31/13. All expire 10 years after their respective vesting dates.
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(
5)
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These options may only be exercised between the following dates: (i) the first to occur of: (A) the commencement of the next trial with respect to the opioid overdose reversal treatment; (B) the entrance into a distribution, licensing, royalty, partnership, collaboration, or other significant transaction with respect to the opioid overdose reversal treatment; or (C) the filing of a New Drug Application with the U.S. Food and Drug Administration with respect to the opioid overdose reversal treatment; and (ii) the Expiration Date.
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(
6)
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These options may only be exercised between the following dates: (i) the first to occur of: (A) the commencement of three trials on or subsequent to October 23, 2015; or (B) (1) the approval by the U.S. Food and Drug Administration of the New Drug Application with respect to the opioid overdose reversal treatment; and (2) the commencement of two trials on or subsequent to October 23, 2015; and (ii) the Expiration Date.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Pollack Kevin
445 PARK AVENUE, 9TH FLOOR
NEW YORK, NY 10022
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X
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X
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Chief Financial Officer
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Signatures
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/s/ Kevin Pollack
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10/29/2015
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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