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