SEC FORM 3

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^*

Appajosyula Sireesh

(Last)

(First)

(Middle)

C/O HILLSTREAM BIOPHARMA, INC.

1200 ROUTE 22 EAST, SUITE 2000

(Street)

BRIDGEWATER

08807

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
01/11/2022

3. Issuer Name and Ticker or Trading Symbol
Hillstream BioPharma Inc. [ HILS ]

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)
Common stock	284,090	D
Common stock	972,222	I	See footnote⁽¹⁾
Common stock	75,757	I	See footnote⁽²⁾

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)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	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)
Options (right to purchase)	⁽³⁾	08/30/2024	Common stock	37,878	$0.0792	D

Explanation of Responses:

1. The shares of common stock are owned by Highpoint Pharmaceuticals LLC. Sireesh Appajosyula is the Managing Member of Highpoint Pharmaceuticals LLC and in such capacity has the right to vote and dispose of the securities held by such entity.

2. The shares of common stock are owned by Mercer Lake Group LLC. Sireesh Appajosyula is the is the Managing Member of Mercer Lake Group LLC and in such capacity has the right to vote and dispose of the securities held by such entity.

3. The Registrant issued the Reporting Person the options on August 30, 2019. The options vested immediately upon grant and become exercisable upon (i) consummation of the Registrant's initial public offering of its securities or (ii) consummation of a reverse merger of the Registrant with and into a public company.

Remarks:

Exhibit List: Exhibit 24 - Power of Attorney

	/s/ Randy Milby as Attorney-In-Fact for Sireesh Appajosyula	01/11/2022
	** 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.
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