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 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 | ||||
Warrant (right to buy) | 08/25/2020 | 08/25/2027 | Common Stock | 21,854 | $ 5.9 | I | By Flagship Consulting, Inc. |
Warrant (right to buy) | 08/25/2021 | 08/25/2027 | Common Stock | 150,000 | $ 5.9 | I | By Flagship Consulting, Inc. |
Convertible Note | (1) | 12/31/2021 | Common Stock | (1) | $ (1) | I | By Flagship Consulting, Inc. |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
FRATTAROLI JOSEPH 3350 RIVERWOOD PARKWAY SE, SUITE 1900 ATLANTA, GA 30339 |
Chief Financial Officer |
/s/ Milton H. Werner, attorney-in-fact | 12/22/2020 | |
**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) | The Convertible Note has a maturity date of December 31, 2021. Prior to the maturity date, the Convertible Note will automatically convert into common stock of the Issuer if, on or prior to December 31, 2020, the Issuer consummates an initial public offering ("IPO") and will convert into such number of shares of common stock equal to the principal amount of the note, plus accrued and unpaid interest (which accrues at a rate of 5% per annum) as of the closing of the IPO, divided by the IPO price. |
Remarks: Exhibit List: Exhibit 24 - Power of Attorney |