Sec Form 3 Filing - KEYSER D JEFFREY @ Lantern Pharma Inc. - 2020-06-10

Insider filing report for Changes in Beneficial Ownership
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FORM 3
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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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1. Name and Address of Reporting Person
KEYSER D JEFFREY
2. Issuer Name and Ticker or Trading Symbol
Lantern Pharma Inc. [ LTRN]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O LANTERN PHARMA INC., 1920 MCKINNEY AVENUE, 7TH FLOOR
3. Date of Earliest Transaction (MM/DD/YY)
06/10/2020
(Street)
DALLAS,, TX75201
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Options $ 1.03 ( 1 ) ( 2 ) ( 2 ) Common Stock 32,538 ( 1 ) ( 2 ) D
Series A Preferred Stock ( 1 ) ( 3 ) ( 3 ) ( 3 ) Common Stock 31,927 ( 1 ) ( 3 ) D
Series A Warrants $ 3.13 ( 1 ) ( 4 ) 05/25/2019 07/25/2024 Common Stock 3,831 ( 1 ) ( 4 ) D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
KEYSER D JEFFREY
C/O LANTERN PHARMA INC.
1920 MCKINNEY AVENUE, 7TH FLOOR
DALLAS,, TX75201
X
Signatures
/s/ Donald Jeffrey Keyser 06/10/2020
Signature of Reporting Person Date
Explanation of Responses:
( 1 )In connection with the Issuer's initial public offering ("IPO"), the Issuer intends to effect a 1.74-for-1 stock split on its outstanding common stock, which will become effective immediately prior to the closing of the Issuer's IPO ("Stock Split"). The share amounts and the price reflect the anticipated Stock Split.
( 2 )The securities beneficially owned by the Reporting Person consists of 32,538 shares of common stock subject to options exercisable within 60 days.
( 3 )The securities beneficially owned by the Reporting Person consists of 18,349 shares of Series A Preferred Stock, which will automatically convert into 31,927 shares of common stock immediately prior to the closing of the Issuer's IPO.
( 4 )The securities beneficially owned by the Reporting Person consists of warrants to purchase up to 2,202 shares of the Issuer's Series A Preferred Stock; provided, that upon the closing of the Issuer's IPO, such warrants will be amended to represent a right to purchase up to 3,831 shares of common stock at $3.13 per share.

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* If the form is filed by more than one reporting person, see Instruction 4(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).

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