0000897069-23-001617.txt : 20231117 0000897069-23-001617.hdr.sgml : 20231117 20231117170932 ACCESSION NUMBER: 0000897069-23-001617 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20231115 FILED AS OF DATE: 20231117 DATE AS OF CHANGE: 20231117 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bay Shore Trust CENTRAL INDEX KEY: 0001986593 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41765 FILM NUMBER: 231419844 BUSINESS ADDRESS: STREET 1: C/O MIRA PHARMACEUTICALS, INC. STREET 2: 900 WEST PLATT STREET, SUITE 200 CITY: TAMPA STATE: FL ZIP: 33606-2173 BUSINESS PHONE: (737) 289-0835 MAIL ADDRESS: STREET 1: C/O MIRA PHARMACEUTICALS, INC. STREET 2: 900 WEST PLATT STREET, SUITE 200 CITY: TAMPA STATE: FL ZIP: 33606-2173 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: McNulty Brian Patrick CENTRAL INDEX KEY: 0001996353 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41765 FILM NUMBER: 231419843 MAIL ADDRESS: STREET 1: C/O MIRA PHARMACEUTICALS, INC. STREET 2: 900 WEST PLATT STREET, SUITE 200 CITY: TAMPA STATE: FL ZIP: 33606-2173 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MIRA PHARMACEUTICALS, INC. CENTRAL INDEX KEY: 0001904286 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 853354547 STATE OF INCORPORATION: FL BUSINESS ADDRESS: STREET 1: 855 N WOLFE STREET #623-6 CITY: BALTIMORE STATE: MD ZIP: 21205 BUSINESS PHONE: 813-369-5150 MAIL ADDRESS: STREET 1: 324 SOUTH HYDE PARK AVENUE, SUITE 350 CITY: TAMPA STATE: FL ZIP: 33606 FORMER COMPANY: FORMER CONFORMED NAME: Mira1a Therapeutics, Inc. DATE OF NAME CHANGE: 20220112 4 1 form4.xml X0508 4 2023-11-15 0001904286 MIRA PHARMACEUTICALS, INC. MIRA 0001986593 Bay Shore Trust 855 N WOLFE STREET SUITE 601 BALTIMORE MD 21205 true 0001996353 McNulty Brian Patrick 855 N WOLFE STREET SUITE 601 BALTIMORE MD 21205 true false Common Stock Warrant (right to buy) 2 2023-11-15 4 A 0 700000 A 2023-11-15 2028-11-15 Common Stock 700000 700000 I See Footnote The warrants were issued to MIRALOGX LLC ("MIRALOGX"), a wholly-owned subsidiary of the Bay Shore Trust (the "Trust"), a greater than 10% owner of the Issuer, in connection with an Exclusive License Agreement, dated November 15, 2023, by and between MIRALOGX and the Issuer. The Trust may be deemed to beneficially own the shares held by MIRALOGX but disclaims beneficial ownership except to the extent of its pecuniary interest therein, if any. /s/ Michelle Yanez, Attorney-in-Fact for Brian McNulty, Trustee 2023-11-17 /s/ Michelle Yanez, Attorney-in-Fact for Brian McNulty 2023-11-17