0001104659-21-010383.txt : 20210201
0001104659-21-010383.hdr.sgml : 20210201
20210201195407
ACCESSION NUMBER: 0001104659-21-010383
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210128
FILED AS OF DATE: 20210201
DATE AS OF CHANGE: 20210201
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Keefer David R
CENTRAL INDEX KEY: 0001825986
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39811
FILM NUMBER: 21578442
MAIL ADDRESS:
STREET 1: 44 MILTON AVENUE
CITY: ALPHARETTA
STATE: GA
ZIP: 30009
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Virios Therapeutics, Inc.
CENTRAL INDEX KEY: 0001818844
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 854314201
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 44 MILTON AVENUE
CITY: ALPHARETTA
STATE: GA
ZIP: 30009
BUSINESS PHONE: 8666208655
MAIL ADDRESS:
STREET 1: 44 MILTON AVENUE
CITY: ALPHARETTA
STATE: GA
ZIP: 30009
FORMER COMPANY:
FORMER CONFORMED NAME: Virios Therapeutics, LLC
DATE OF NAME CHANGE: 20200721
4
1
tm214953-1_4seq1.xml
OWNERSHIP DOCUMENT
X0306
4
2021-01-28
0
0001818844
Virios Therapeutics, Inc.
VIRI
0001825986
Keefer David R
C/O VIRIOS THERAPEUTICS, INC.
44 MILTON AVENUE
ALPHARETTA
GA
30009
1
0
0
0
Common Stock
2021-01-28
4
M
0
1602
7.80
A
7808
I
Ethica Group, LLC
Warrant to Purchase Common Stock
7.80
2021-01-28
4
M
0
1602
0
D
2020-12-16
2021-01-20
Common Stock
1602
0
I
Ethica Group, LLC
The securities are owned directly by Ethica Group, LLC ("Ethica"), the Reporting Person is managing member of Ethica and may be deemed to beneficially own the securities held directly by Ethica.
The Reporting Person provided notice of exercise to the Issuer on January 20, 2021 and the Company authorized the issuance of the shares pursuant to such exercise on January 28, 2020.
/s/ Greg Duncan, Attorney-in-Fact for David R. Keefer
2021-02-01