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) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Warrants
|
04/30/2019 |
04/29/2024 |
Common Stock
|
5,000,000
|
$
3
|
I
|
By Ault Life Sciences Fund, LLC
(1)
|
Warrants
|
03/09/2021 |
03/08/2026 |
Common Stock
|
1,350,000
|
$
3
|
I
|
By Digital Power Lending, LLC
(2)
|
Series A Convertible Preferred Stock
|
(3)
|
(3)
|
Common Stock
|
15,000,000
|
$
(3)
|
I
|
By Ault Life Sciences, Inc.
|
Stock Options (Right to Buy)
|
(4)
|
04/29/2026 |
Common Stock
|
2,500,000
|
$
0.0004
|
D
|
|
* |
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) |
Mr. Ault has sole voting and investment power with respect to the securities held of record by Ault Life Sciences Fund, LLC. |
(2) |
Digital Power Lending, LLC ("DPL") is a wholly-owned subsidiary of Ault Global Holdings, Inc. ("AGH") Mr. Ault, the Executive Chairman of AGH, is deemed to have voting and investment power with respect to the securities held of record by DPL. |
(3) |
The Series A Convertible Preferred Stock (the "Series A Preferred Stock") shall automatically convert into 15,000,000 shares of Common Stock upon the closing of the initial public offering without payment of further consideration. Mr. Ault has sole voting and investment power with respect to the shares of Series A Preferred Stock held of record by Ault Life Sciences, Inc. |
(4) |
Mr. Ault was granted stock options to purchase 2,500,000 shares of Common Stock, which options are exercisable at an exercise price of $0.004 and are currently vested and exercisable. |