UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series A Preferred Stock | Â (2) | Â (2) | Common Stock | 386,415 | $ (2) | I | See Footnote (1) |
Series B Preferred Stock | Â (2) | Â (2) | Common Stock | 31,437 | $ (2) | I | See Footnote (1) |
Series B Preferred Stock | Â (2) | Â (2) | Common Stock | 83,333 | $ (2) | I | See Footnote (3) |
Series B-1 Preferred Stock | Â (2) | Â (2) | Common Stock | 237,500 | $ (2) | I | See Footnote (1) |
Series B-1 Preferred Stock | Â (2) | Â (2) | Common Stock | 20,833 | $ (2) | I | See Footnote (3) |
Series B-1 Preferred Stock | Â (2) | Â (2) | Common Stock | 8,333 | $ (2) | I | See Footnote (4) |
Series C Preferred Stock | Â (2) | Â (2) | Common Stock | 56,874 | $ (2) | I | See Footnote (1) |
Series C Preferred Stock | Â (2) | Â (2) | Common Stock | 81,249 | $ (2) | I | See Footnote (3) |
Series C Preferred Stock | Â (2) | Â (2) | Common Stock | 18,332 | $ (2) | I | See Footnote (4) |
Common Stock Warrant (Right to Buy) | Â (5) | 10/28/2016 | Common Stock | 33,903 | $ 0.024 | I | See Footnote (1) |
Common Stock Warrant (Right to Buy) | Â (5) | 10/28/2016 | Common Stock | 5,208 | $ 0.024 | I | See Footnote (3) |
Common Stock Warrant (Right to Buy) | Â (2) | 10/28/2016 | Common Stock | 1,577 | $ 0.024 | I | See Footnote (4) |
Preferred Stock Warrant (Right to Buy) | Â (6) | 02/19/2018 | Series C Preferred Stock | 14,791 (6) | $ 5 (6) | I | See Footnote (3) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Iannelli Ralph C/O NEOS THERAPEUTICS, INC. 2940 N. HIGHWAY 360 GRAND PRAIRIE, TX 75050 |
 |  X |  |  |
Essex Capital Corp C/O NEOS THERAPEUTICS, INC. 2940 N. HIGHWAY 360 GRAND PRAIRIE, TX 75050 |
 |  X |  |  |
/s/ Benjamin Piper, attorney-in-fact | 07/22/2015 | |
**Signature of Reporting Person | Date | |
/s/ Benjamin Piper, attorney-in-fact | 07/22/2015 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Security listed in column 1 is held directly by Essex Capital Corporation ("Essex"), of which Ralph Iannelli is the sole stockholder. |
(2) | The Series B preferred stock, Series B-1 preferred stock and Series C preferred stock are convertible into common stock on a 2.4-for-1 basis into the number of shares of common stock as shown in column 3 at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering. The Series B preferred stock, Series B-1 preferred stock and Series C preferred stock have no expiration date. |
(3) | Security listed in column 1 is held directly by KF Investment Partners, LP ("KF"). Essex is the 50% limited partner of KF, and Ralph Iannelli is the General Partner of KF and may be deemed to have voting and dispositive power with respect to such shares. Each Reporting Person disclaims beneficial ownership of such shares, except to the extent of its pecuniary interest therein. |
(4) | Security listed in column 1 is held directly in the name of of SIU Capital LLC ("SIU"). Essex is the 50% limited partner of SIU, and Ralph Iannelli is the Managing Member of SIU, and may be deemed to have voting and dispositive power with respect to such shares. Each Reporting Person disclaims beneficial ownership of such shares, except to the extent of its pecuniary interest therein. |
(5) | The warrant is exercisable at any time at the holder's election for the number of shares of common stock shown in column 3. |
(6) | The warrant is exercisable at the earlier of (i) the holder's election for the number of shares of Series C preferred stock (a) shown in column 3 at a price of $5.00 per share of Series C preferred stock or (b) such number of shares issuable pursuant to a cashless net exercise provision pursuant to which the holder surrenders the warrant and recieves a net number of shares of Series C preferred stock based on the fair market value of such stock at the time of exercise, after deducting the aggregate exercise price (the "Cashless Exercise Provision"); and (ii) immediately prior to the closing of the Issuer's initial public offering pursuant to the Cashless Exercise Provision. |
 Remarks: Exhibit List: Exhibit 24.1 - Power of Attorney |