0001013762-24-003550.txt : 20240801 0001013762-24-003550.hdr.sgml : 20240801 20240801091158 ACCESSION NUMBER: 0001013762-24-003550 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240731 FILED AS OF DATE: 20240801 DATE AS OF CHANGE: 20240801 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ciccio John CENTRAL INDEX KEY: 0001974196 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-42195 FILM NUMBER: 241164669 MAIL ADDRESS: STREET 1: C/O OS THERAPIES INCORPORATED STREET 2: 15825 SHADY GROVE ROAD, SUITE 135 CITY: ROCKVILLE STATE: MD ZIP: 20850 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: OS Therapies Inc CENTRAL INDEX KEY: 0001795091 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] ORGANIZATION NAME: 03 Life Sciences IRS NUMBER: 825118368 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 15825 SHADY GROVE ROAD STREET 2: SUITE 135 CITY: ROCKVILLE STATE: MD ZIP: 20850 BUSINESS PHONE: 410-297-7793 MAIL ADDRESS: STREET 1: 15825 SHADY GROVE ROAD STREET 2: SUITE 135 CITY: ROCKVILLE STATE: MD ZIP: 20850 FORMER COMPANY: FORMER CONFORMED NAME: OS THERAPIES Inc DATE OF NAME CHANGE: 20191125 3 1 ownership.xml X0206 3 2024-07-31 0 0001795091 OS Therapies Inc OSTX 0001974196 Ciccio John C/O OS THERAPIES INCORPORATED 15825 SHADY GROVE ROAD, SUITE 135 ROCKVILLE MD 20850 1 0 0 0 Common stock, par value $0.001 per share ("Common Stock") 20000 D Common Stock 37500 I Mill River Partners LLC Convertible Promissory Note 2024-10-31 Common Stock 25000 I Mill River Partners LLC Convertible Promissory Note 2024-10-31 Common Stock 75000 I Mill River Partners LLC Convertible Promissory Note 2024-10-31 Common Stock 50000 I Mill River Partners LLC John Ciccio serves on the board of managers of Mill River Partners LLC and shares voting and investment power with respect to these shares. Represents the outstanding principal amount of convertible promissory notes held by Mill River Partners LLC, which will automatically convert upon consummation of the Issuer's initial public offering into shares of Common Stock at a conversion price of 80% of the price per share in the Issuer's initial public offering, subject to a valuation ceiling of $19 million. Represents the outstanding principal amount of a convertible promissory note held by Mill River Partners LLC, which will automatically convert upon consummation of the Issuer's initial public offering into shares of Common Stock at a conversion price of 50% of the price per share in the Issuer's initial public offering, subject to a valuation ceiling of $50 million. /s/ John Ciccio 2024-07-31