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
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
FEIGHAN EDWARD F

(Last) (First) (Middle)
1901 AVENUE OF THE STARS, 2ND FLOOR

(Street)
LOS ANGELES CA 90067

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/15/2018
3. Issuer Name and Ticker or Trading Symbol
Vitality Biopharma, Inc. [ VBIO ]
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 602,876(1) D
Common Stock 217,624 I By The Feighan Family Fund LLC(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)
Date Exercisable Expiration Date Title Amount or Number of Shares
Common Stock Warrants (right to buy) 10/22/2018 10/22/2023 Common Stock 502,500(3) $3 D
Common Stock Warrants (right to buy) 10/22/2018 10/22/2023 Common Stock 167,500 $3 I By the Feighan Family Fund LLC(4)
Explanation of Responses:
1. In connection with a Securities Purchase Agreement dated October 19, 2018, Mr. Feighan acquired 502,500 shares of the Company's common stock. In connection with a Share Exchange Agreement dated October 19, 2018, Mr. Feighan acquired 100,376 shares of the Company's common stock.
2. In connection with a Securities Purchase Agreement dated October 19, 2018, The Feighan Family Fund LLC, an entity beneficially owned by Mr. Feighan (the "LLC") acquired 167,500 shares of the Company's common stock. In connection with a Share Exchange Agreement dated October 19, 2018, the LLC acquired 50,124 shares of the Company's common stock. Mr. Feighan may be deemed to indirectly beneficially own common stock held directly by the LLC and disclaims beneficial ownership of all such common stock.
3. In connection with a Securities Purchase Agreement dated October 19, 2018, Mr. Feighan received a warrant to purchase 502,500 shares of the Company's common stock.
4. In connection with a Securities Purchase Agreement dated October 19, 2018, The Feighan Family Fund LLC, an entity beneficially owned by Mr.Feighan (the "LLC") received a warrant to purchase 167,500 shares of the Company's common stock. Mr. Feighan may be deemed to indirectly beneficially own common stock held directly by the LLC and disclaims beneficial ownership of all such common stock.
/s/ Edward F. Feighan 11/21/2018
** 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.