0001213900-20-029373.txt : 20200930
0001213900-20-029373.hdr.sgml : 20200930
20200930210044
ACCESSION NUMBER: 0001213900-20-029373
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200929
FILED AS OF DATE: 20200930
DATE AS OF CHANGE: 20200930
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Hallock Kenneth
CENTRAL INDEX KEY: 0001806925
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39555
FILM NUMBER: 201214022
MAIL ADDRESS:
STREET 1: 2311 SPARTAN TRAIL
CITY: SUGAR LAND
STATE: TX
ZIP: 77479
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Greenwich LifeSciences, Inc.
CENTRAL INDEX KEY: 0001799788
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 205473709
STATE OF INCORPORATION: TX
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 3992 BLUEBONNET DR, BUILDING 14
CITY: STAFFORD
STATE: TX
ZIP: 77477
BUSINESS PHONE: 203-434-3290
MAIL ADDRESS:
STREET 1: 3992 BLUEBONNET DR, BUILDING 14
CITY: STAFFORD
STATE: TX
ZIP: 77477
4
1
ownership.xml
X0306
4
2020-09-29
0
0001799788
Greenwich LifeSciences, Inc.
GLSI
0001806925
Hallock Kenneth
C/O GREENWICH LIFESCIENCES, INC.
3992 BLUEBONNET DR., BUILDING 14
STAFFORD
TX
77477
1
0
0
0
Common Stock
2020-09-29
4
M
0
18727
A
276095
I
see footnote
Common Stock
2020-09-29
4
M
0
18727
A
294822
I
see footnote
Common Stock
2020-09-29
4
M
0
79121
A
386671
I
see footnote
Series B Preferred Stock
2020-09-29
4
M
0
18727
0
D
Common Stock
18727
0
I
see footnote
Series C Preferred Stock
2020-09-29
4
M
0
18727
0
D
Common Stock
18727
0
I
see footnote
Series D Preferred Stock
2020-09-29
4
M
0
79121
0
D
Common Stock
79121
0
I
see footnote
Series D Preferred Stock
2020-09-29
4
J
0
12728
0
A
Common Stock
12728
12728
I
see footnote
Series D Preferred Stock
2020-09-29
4
M
0
12728
0
D
Common Stock
12728
0
I
see footnote
The securities are owned by the Kenneth and Annette Hallock Revocable Trust (the "Hallock Trust"). Kenneth Hallock, as co-Trustee of the Hallock Trust, shares voting and dispositive power over the securities held by such trust with his spouse.
The Series B Preferred Stock converted into Issuer common stock on a 1-for-1 basis and had no expiration date.
The Series C Preferred Stock converted into Issuer common stock on a 1-for-1 basis and had no expiration date.
The Series D Preferred Stock converted into Issuer common stock on a 1-for-1 basis and had no expiration date.
The Series D Preferred Stock have no expiration date and are convertible, at the option of the holder, into shares of common stock of the Issuer at the then-effective conversion rate for no additional consideration (subject to the payment of cash, if applicable, in lieu of any fractional shares in accordance with the Issuer's Amended and Restated Certificate of Incorporation, as amended (the "Certificate of Incorporation").
The Reporting Person was issued additional shares of Series D Preferred Stock in connection with the Issuer's initial public offering as a result of the anti-dilution protection provisions set forth in the Issuer's Certificate of Incorporation.
/s/ Kenneth Hallock
2020-09-30