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) 05/08/2019 | 3. Issuer Name and Ticker or Trading Symbol Vitality Biopharma, Inc. [ VBIO ] | |||||||||||||
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(1) | 10,000 | D(2) |
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 | ||||
Employee Stock Option (Right to Buy) | 01/01/2015(3) | 08/06/2022 | Common Stock | 10,000(2) | 2.7 | D | |
Employee Stock Option (Right to Buy) | 01/01/2017(4) | 01/01/2025 | Common Stock | 20,000(2) | 3.4 | D | |
Employee Stock Option (Right to Buy) | 05/21/2017(5) | 05/21/2025 | Common Stock | 20,000(2) | 2.1 | D | |
Employee Stock Option (Right to Buy) | 07/15/2018(6) | 07/18/2026 | Common Stock | 370,234 | 0.5 | D | |
Employee Stock Option (Right to Buy) | 06/27/2018(7) | 12/27/2027 | Common Stock | 75,000 | 1.81 | D |
Explanation of Responses: |
1. Represents 10,000 shares earned by the Reporting Person as the result of the vesting of a restricted stock bonus award granted to the Reporting Person on July 30, 2012. |
2. On July 15, 2016, the Issuer effected a 10 to 1 reverse stock split of its common stock (the "Reverse Stock Split"). The amount of securities reported on this Form 3 have been adjusted to reflect the Reverse Stock Split. |
3. The Reporting Person was granted 10,000 options on August 6, 2012, which are fully vested. |
4. The Reporting Person was granted 20,000 options on January 1, 2015, which are fully vested. |
5. The Reporting Person was granted 20,000 options on May 21, 2015, which are fully vested. |
6. The Reporting Person was granted 370,234 options on July 15, 2016, which are fully vested. |
7. Of the 75,000 options granted on December 27, 2017, of which 37,500 shares have vested, 18,750 shares will vest on June 27, 2019, and 18,750 shares will vest on December 27, 2019. |
/s/ Richard McKilligan | 05/20/2019 | |
** 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. |