SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL 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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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 12/21/2021 | 3. Issuer Name and Ticker or Trading Symbol MARIZYME INC [ MRZM ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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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 | 175,000(1) | I | By AAT Services Inc. |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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: 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 | ||||
Consultant Stock Option (Right to Buy) | (2) | 12/21/2031 | Common Stock | 200,000 | 1.75 | I | By AAT Services Inc. |
Warrants (Right to Buy) | 12/21/2021 | 12/21/2026 | Common Stock | 100,000 | 1.26 | I | By AAT Services Inc. |
Explanation of Responses: |
1. Restricted shares of common stock of the issuer (the "Restricted Shares"), subject to the following milestone vesting schedule: (a) 75,000 Restricted Shares will vest upon the issuer successfully listing its common stock on NASDAQ or the NYSE; 50,000 Restricted Shares will vest upon any issuer financing after January 1, 2022 of debt or equity in which the gross proceeds equal or exceed $5,000,000; (c) 25,000 Restricted Shares will vest upon the completion of valuation reports for both Somahlution LLC and Health Logic Interactive Inc.; and (d) 25,000 Restricted Shares will vest upon a material commercial partnership for the issuer's MATLOC product. |
2. Vests monthly over two years following the date of grant on December 21, 2021. |
/s/ Georgiy (George) Kovalyov | 01/13/2022 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* 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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |