1. Name and Address of Reporting Person * |
Patel Snehal |
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2. Date of Event Requiring Statement (Month/Day/Year) 09/24/2020 |
3. Issuer Name and Ticker or Trading Symbol Greenwich LifeSciences, Inc. [GLSI]
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C/O GREENWICH LIFESCIENCES, INC., 3992 BLUEBONNET DR, BUILDING 14 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__X__ Director |
_____ 10% Owner |
__X__ Officer (give title below) |
_____ Other (specify below) |
CHIEF EXECUTIVE OFFICER |
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5. If Amendment, Date Original Filed(Month/Day/Year)
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STAFFORD, TX 77477 |
6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned |
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1.Title of Security (Instr. 4) |
2. Amount of Securities Beneficially Owned (Instr. 4) |
3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) |
4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common stock
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749,336
(1)
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D
|
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Common stock
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176,798
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I
|
See footnote
(2)
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Common stock
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2,405,670
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I
|
See footnote
(3)
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Common stock
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1,320,226
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I
|
See footnote
(4)
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Common stock
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1,329,590
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I
|
See footnote
(5)
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* |
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) |
Includes a grant of 749,064 shares of the Issuer's common stock that vests as follows: 93,633 shares of common stock vested immediately upon grant, and the balance, or 655,431 shares of common stock vests in 36 equal installments on the 1st of every month with the first installment vesting on October 1, 2019. |
(2) |
The securities are owned by Snehal Patel IRA. Snehal Patel is the Trustee of Snehal Patel IRA, and in such capacity is deemed to hold voting and dispositive power over the securities held by such IRA. |
(3) |
The securities are owned by Patel Family Trust 1. Snehal Patel, as co-Trustee of Patel Family Trust 1, shares voting and dispositive power over the securities held by such trust with his spouse. |
(4) |
The securities are owned by Patel Family Trust 2. Snehal Patel, as co-Trustee of Patel Family Trust 2, shares voting and dispositive power over the securities held by such trust with his spouse. |
(5) |
The securities are owned by Patel Family Trust 3. Snehal Patel, as co-Trustee of Patel Family Trust 3, shares voting and dispositive power over the securities held by such trust with his spouse. |
(6) |
The Series A Preferred Stock have no expiration date and are convertible, at the option of the holder, into shares of common stock of the Issuer at the then-effective conversion rate for no additional consideration (subject to the payment of cash, if applicable, in lieu of any fractional shares in accordance with the Issuer's Amended and Restated Certificate of Incorporation (as amended, the "Certificate of Incorporation")). The shares of Series A Preferred Stock will automatically convert into shares of the Issuer's common stock at the then-effective conversion rate for no additional consideration (subject to the payment of cash, if applicable, in lieu of any fractional shares in accordance with the Certificate of Incorporation) immediately prior to the closing of the Issuer's initial public offering. |
(7) |
The Series B Preferred Stock have no expiration date and are convertible, at the option of the holder, into shares of common stock of the Issuer at the then-effective conversion rate for no additional consideration (subject to the payment of cash, if applicable, in lieu of any fractional shares in accordance with the Certificate of Incorporation). The shares of Series B Preferred Stock will automatically convert into shares of the Issuer's common stock at the then-effective conversion rate for no additional consideration (subject to the payment of cash, if applicable, in lieu of any fractional shares in accordance with the Certificate of Incorporation) immediately prior to the closing of the Issuer's initial public offering. |
(8) |
The Series C Preferred Stock have no expiration date and are convertible, at the option of the holder, into shares of common stock of the Issuer at the then-effective conversion rate for no additional consideration (subject to the payment of cash, if applicable, in lieu of any fractional shares in accordance with the Certificate of Incorporation). The shares of Series C Preferred Stock will automatically convert into shares of the Issuer's common stock at the then-effective conversion rate for no additional consideration (subject to the payment of cash, if applicable, in lieu of any fractional shares in accordance with the Certificate of Incorporation) immediately prior to the closing of the Issuer's initial public offering. |
(9) |
The Series D Preferred Stock have no expiration date and are convertible, at the option of the holder, into shares of common stock of the Issuer at the then-effective conversion rate for no additional consideration (subject to the payment of cash, if applicable, in lieu of any fractional shares in accordance with the Certificate of Incorporation). The shares of Series D Preferred Stock will automatically convert into shares of the Issuer's common stock at the then-effective conversion rate for no additional consideration (subject to the payment of cash, if applicable, in lieu of any fractional shares in accordance with the Certificate of Incorporation) immediately prior to the closing of the Issuer's initial public offering. |
(10) |
The Series A Preferred Stock is convertible into shares of the Issuer's common stock at a 1-for-1 conversion rate. |
(11) |
The Series B Preferred Stock is convertible into shares of the Issuer's common stock at a 1-for-1 conversion rate. |
(12) |
The Series C Preferred Stock is convertible into shares of the Issuer's common stock at a 1-for-1 conversion rate. |
(13) |
The Series D Preferred Stock is convertible into shares of the Issuer's common stock at a 1-for-1 conversion rate. |
(14) |
Kinnary Patel is the spouse of Snehal Patel and Trustee of the Kinnary Patel IRA. |