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