0001104659-20-008249.txt : 20200129
0001104659-20-008249.hdr.sgml : 20200129
20200129201008
ACCESSION NUMBER: 0001104659-20-008249
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200128
FILED AS OF DATE: 20200129
DATE AS OF CHANGE: 20200129
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Bruck Claudine
CENTRAL INDEX KEY: 0001733680
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39202
FILM NUMBER: 20559537
MAIL ADDRESS:
STREET 1: 4995 BRADENTON AVE, SUITE 240
CITY: DUBLIN
STATE: OH
ZIP: 43017-3552
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Annovis Bio, Inc.
CENTRAL INDEX KEY: 0001477845
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 262540421
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1055 WESTLAKES DRIVE, SUITE 300
CITY: BERWYN
STATE: PA
ZIP: 19312
BUSINESS PHONE: 610-727-3913
MAIL ADDRESS:
STREET 1: 1055 WESTLAKES DRIVE, SUITE 300
CITY: BERWYN
STATE: PA
ZIP: 19312
FORMER COMPANY:
FORMER CONFORMED NAME: QR Pharma, Inc.
DATE OF NAME CHANGE: 20091202
3
1
a3.xml
3
X0206
3
2020-01-28
0
0001477845
Annovis Bio, Inc.
ANVS
0001733680
Bruck Claudine
C/O ANNOVIS BIO, INC.
1055 WESTLAKES DRIVE, SUITE 300
BERWYN
PA
19312
1
0
0
0
Convertible Note
Common Stock
D
Series A-1 Preferred Stock
Common Stock
5556
D
Stock Option (right to buy)
0.14
2028-04-06
Common Stock
24997
D
Stock Option (right to buy)
0.25
2026-04-07
Common Stock
7142
D
The Convertible Notes have a maturity date of December 31, 2023. Prior to the maturity date, the Convertible Notes will automatically convert into common stock of Annovis Bio, Inc. ("Annovis") upon an initial public offering ("IPO") of Annovis at a conversion rate equal to the principal amount of the note, plus accrued and unpaid interest, divided by 80% of the public offering price per share of the IPO as set forth on the cover page of the final prospectus for the IPO.
Each share of Series A-1 Preferred Stock is convertible into common stock of Annovis and has no expiration date. Upon the closing of the IPO, 7,778 shares of Series A-1 Preferred Stock, along with the aggregate accrued or accumulated and unpaid dividends thereon, will automatically be converted into 5,556 shares of common stock of the Issuer.
As of the date of this report, all of the shares underlying the options are fully vested and exercisable.
/s/ Maria Maccecchini Attorney-in-Fact
2020-01-29