0001493152-22-001677.txt : 20220120 0001493152-22-001677.hdr.sgml : 20220120 20220120092512 ACCESSION NUMBER: 0001493152-22-001677 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220114 FILED AS OF DATE: 20220120 DATE AS OF CHANGE: 20220120 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MILBY RANDY CENTRAL INDEX KEY: 0001360968 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41210 FILM NUMBER: 22540877 MAIL ADDRESS: STREET 1: 5 JACK LANE CITY: NEWARK STATE: DE ZIP: 19711 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Hillstream BioPharma Inc. CENTRAL INDEX KEY: 0001861657 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 842642541 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1200 ROUTE 22 EAST CITY: BRIDGEWATER STATE: NJ ZIP: 08807 BUSINESS PHONE: 302-743-2995 MAIL ADDRESS: STREET 1: 245 MAIN STREET STREET 2: SUITE 204 CITY: CHESTER STATE: NJ ZIP: 07930 4 1 ownership.xml X0306 4 2022-01-14 0 0001861657 Hillstream BioPharma Inc. HILS 0001360968 MILBY RANDY C/O HILLSTREAM BIOPHARMA, INC. 1200 ROUTE 22 EAST, SUITE 2000 BRIDGEWATER NJ 08807 1 1 0 0 Chief Executive Officer Common Stock 2022-01-14 4 C 0 14942 3.20 A 2171992 D Common Stock 2022-01-14 4 C 0 23205 3.20 A 2195197 D Common Stock 2022-01-14 4 C 0 406 3.20 A 2195603 D Common Stock 2022-01-14 4 C 0 23187 3.20 A 2218790 D Common Stock 2022-01-14 4 C 0 16528 3.20 A 2235318 D Common Stock 2022-01-14 4 C 0 15824 3.20 A 2251142 D Common Stock 2022-01-14 4 C 0 6587 3.20 A 2257729 D Common Stock 2022-01-14 4 C 0 16453 3.20 A 2274182 D Common Stock 2022-01-14 4 C 0 21653 3.20 A 2295835 D Common Stock 2022-01-14 4 C 0 13111 3.20 A 2308946 D Common Stock 2022-01-14 4 C 0 24541 3.20 A 2333487 D Common Stock 2022-01-14 4 C 0 19613 3.20 A 2353100 D Common Stock 2022-01-14 4 C 0 22327 3.20 A 2375427 D Common Stock 2022-01-14 4 C 0 24425 3.20 A 2399852 D Common Stock 2022-01-14 4 C 0 17872 3.20 A 2417724 D Convertible Note 3.20 2022-01-14 4 C 0 45000 0 D Common stock 14942 0 D Convertible Note 3.20 2022-01-14 4 C 0 70000 0 D Common stock 23205 0 D Convertible Note 3.20 2022-01-14 4 C 0 1225.37 0 D Common stock 406 0 D Convertible Note 3.20 2022-01-14 4 C 0 70000 0 D Common stock 23187 0 D Convertible Note 3.20 2022-01-14 4 C 0 50000 0 D Common stock 16528 0 D Convertible Note 3.20 2022-01-14 4 C 0 48000 0 D Common stock 15824 0 D Convertible Note 3.20 2022-01-14 4 C 0 20000 0 D Common stock 6587 0 D Convertible Note 3.20 2022-01-14 4 C 0 50000 0 D Common stock 16453 0 D Convertible Note 3.20 2022-01-14 4 C 0 66000 0 D Common stock 21653 0 D Convertible Note 3.20 2022-01-14 4 C 0 40000 0 D Common stock 13111 0 D Convertible Note 3.20 2022-01-14 4 C 0 75000 0 D Common stock 24541 0 D Convertible Note 3.20 2022-01-14 4 C 0 60000 0 D Common stock 19613 0 D Convertible Note 3.20 2022-01-14 4 C 0 68476.50 0 D Common stock 22327 0 D Convertible Note 3.20 2022-01-14 4 C 0 75000 0 D Common stock 24425 0 D Convertible Note 3.20 2022-01-14 4 C 0 55000 0 D Common stock 17872 0 D On October 14, 2020, the Registrant issued the Reporting Person a $45,000 note which matures on the earlier of (i) October 14, 2022 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the note together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. On October 27, 2020, the Registrant issued the Reporting Person notes in the aggregate principal amount of $70,000. The notes mature on the earlier of (i) October 27, 2022 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the notes together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. On November 1, 2020, the Registrant issued the Reporting Person a $1,225.37 note which matures on the earlier of (i) November 1, 2022 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the note together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. On November 2, 2020, the Registrant issued the Reporting Person a $70,000 note which matures on the earlier of (i) November 2, 2022 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the note together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. On November 18, 2020, the Registrant issued the Reporting Person a $50,000 note which matures on the earlier of (i) November 18, 2022 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the note together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. On December 9, 2020, the Registrant issued the Reporting Person a $48,000 note which matures on the earlier of (i) December 9, 2023 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the note together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. On December 16, 2020, the Registrant issued the Reporting Person a $20,000 note which matures on the earlier of (i) December 16, 2023 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the note together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. On December 23, 2020, the Registrant issued the Reporting Person a $50,000 note which matures on the earlier of (i) December 23, 2023 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the note together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. On January 15, 2021, the Registrant issued the Reporting Person a $66,000 note which matures on the earlier of (i) January 15, 2024 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the note together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. On January 22, 2021, the Registrant issued the Reporting Person a $40,000 note which matures on the earlier of (i) January 22, 2024 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the note together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. On February 4, 2021, the Registrant issued the Reporting Person a $75,000 note which matures on the earlier of (i) February 4, 2024 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the note together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. On February 12, 2021, the Registrant issued the Reporting Person a $60,000 note which matures on the earlier of (i) February 12, 2024 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the note together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. On March 3, 2021, the Registrant issued the Reporting Person notes in the aggregate principal amount of $68,476.50. The notes mature on the earlier of (i) March 3, 2024 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the notes together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. On March 12, 2021, the Registrant issued the Reporting Person a $75,000 note which matures on the earlier of (i) March 12, 2024 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the note together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. On March 29, 2021, the Registrant issued the Reporting Person a $55,000 note which matures on the earlier of (i) March 29, 2024 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the note together with accrued interest thereon automatically converts into the type of Equity Securities (as defined therein) issued in the Next Equity Financing. Pursuant to the terms of the note, because the Registrant's initial public offering qualified as a Next Equity Financing, the note automatically converted into shares of the Registrant's common stock. This is the second of the Form 4s. /s/ Randy Milby 2022-01-20