0001493152-22-001680.txt : 20220120 0001493152-22-001680.hdr.sgml : 20220120 20220120092650 ACCESSION NUMBER: 0001493152-22-001680 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: 22540881 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 8101 3.20 A 2425825 D Common Stock 2022-01-14 4 C 0 11325 3.20 A 2437150 D Common Stock 2022-01-14 4 C 0 3231 3.20 A 2440381 D Common Stock 2022-01-14 4 C 0 11545 3.20 A 2451926 D Common Stock 2022-01-14 4 C 0 29026 3.20 A 2480952 D Common Stock 2022-01-14 4 C 0 28366 3.20 A 2509318 D Common Stock 2022-01-14 4 C 0 19296 3.20 A 2528614 D Common Stock 2022-01-14 4 C 0 9639 3.20 A 2538253 D Common Stock 2022-01-14 4 C 0 22420 3.20 A 2560673 D Common Stock 2022-01-14 4 C 0 35175 3.20 A 2595848 D Common Stock 2022-01-14 4 C 0 26325 3.20 A 2622173 D Common Stock 2022-01-14 4 C 0 9572 3.20 A 2631745 D Common Stock 2022-01-14 4 C 0 31204 3.20 A 2662949 D Common Stock 2022-01-14 4 C 0 31064 3.20 A 2694013 D Convertible Note 3.20 2022-01-14 4 C 0 25000 0 D Common stock 8101 0 D Convertible Note 3.20 2022-01-14 4 C 0 35000 0 D Common stock 11325 0 D Convertible Note 3.20 2022-01-14 4 C 0 10000 0 D Common stock 3231 0 D Convertible Note 3.20 2022-01-14 4 C 0 35750 0 D Common stock 11545 0 D Convertible Note 3.20 2022-01-14 4 C 0 90000 0 D Common stock 29026 0 D Convertible Note 3.20 2022-01-14 4 C 0 88000 0 D Common stock 28366 0 D Convertible Note 3.20 2022-01-14 4 C 0 59990 0 D Common stock 19296 0 D Convertible Note 3.20 2022-01-14 4 C 0 30000 0 D Common stock 9639 0 D Convertible Note 3.20 2022-01-14 4 C 0 70000 0 D Common stock 22420 0 D Convertible Note 3.20 2022-01-14 4 C 0 110000 0 D Common stock 35175 0 D Convertible Note 3.20 2022-01-14 4 C 0 82500 0 D Common stock 26325 0 D Convertible Note 3.20 2022-01-14 4 C 0 30250 0 D Common stock 9572 0 D Convertible Note 3.20 2022-01-14 4 C 0 99000 0 D Common stock 31204 0 D Convertible Note 3.20 2022-01-14 4 C 0 99000 0 D Common stock 31064 0 D Options (right to purchase) 4 2022-01-14 4 A 0 757575 0 A 2032-01-14 Common stock 757575 757575 D On April 19, 2021, the Registrant issued the Reporting Person a $25,000 note which matures on the earlier of (i) April 19, 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 April 30, 2021, the Registrant issued the Reporting Person a $35,000 note which matures on the earlier of (i) April 30, 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 May 10, 2021, the Registrant issued the Reporting Person a $10,000 note which matures on the earlier of (i) May 10, 2024 and (ii) the closing of the Next Equity Financing (as defined therein). The principal amount of the note together with accrued interest thereon shall 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 May 15, 2021, the Registrant issued the Reporting Person a $35,750 note which matures on the earlier of (i) May 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 May 25, 2021, the Registrant issued the Reporting Person a $90,000 note which matures on the earlier of (i) May 25, 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 May 29, 2021, the Registrant issued the Reporting Person an $88,000 note which matures on the earlier of (i) May 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. On June 14, 2021, the Registrant issued the Reporting Person a $59,990 note which matures on the earlier of (i) June 14, 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 June 22, 2021, the Registrant issued the Reporting Person a $30,000 note which matures on the earlier of (i) June 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 July 16, 2021, the Registrant issued the Reporting Person a $70,000 note which matures on the earlier of (i) July 17, 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 July 28, 2021, the Registrant issued the Reporting Person a $110,000 note which matures on the earlier of (i) July 28, 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 August 13, 2021, the Registrant issued the Reporting Person an $82,500 note which matures on the earlier of (i) August 13, 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 October 14, 2021, the Registrant issued the Reporting Person a $30,250 note which matures on the earlier of (i) October 14, 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 November 12, 2021, the Registrant issued the Reporting Person a $99,000 note which matures on the earlier of (i) November 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 December 15, 2021, the Registrant issued the Reporting Person a $99,000 note which matures on the earlier of (i) December 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. The Registrant issued the Reporting Person options on January 14, 2022. The options vest over a 48 month period commencing 12 months after the date of grant. This is the third of the Form 4s. /s/ Randy Milby 2022-01-20