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