SEC FORM
4
SEC Form 4
FORM 4 |
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 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
1. Name and Address of Reporting Person*
36 ROBINSON ROAD |
#13-01 CITY HOUSE |
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Outlook Therapeutics, Inc.
[ OTLK ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X |
Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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3. Date of Earliest Transaction
(Month/Day/Year) 01/27/2020
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Form filed by One Reporting Person |
X |
Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
01/29/2020 |
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M |
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4,657,852 |
A |
$0.232
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21,606,437 |
D
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Warrant (Right to Buy) |
$7.2
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01/27/2020 |
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D
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2,093,750
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10/31/2025 |
Common Stock |
2,093,750 |
$0.00
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0 |
D
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Warrant (Right to Buy) |
$0.232
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01/27/2020 |
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A
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2,093,750 |
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10/31/2025 |
Common Stock |
2,039,750 |
$0.00
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2,039,750 |
D
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Warrant (Right to Buy) |
$7.8
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01/27/2020 |
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D
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1,282,051
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05/14/2026 |
Common Stock |
1,282,051 |
$1
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0 |
D
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Warrant (Right to Buy) |
$0.232
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01/27/2020 |
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A
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1,282,051 |
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05/14/2026 |
Common Stock |
1,282,051 |
$1
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1,282,051 |
D
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Warrant (Right to Buy) |
$7.8
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01/27/2020 |
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D
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1,282,051
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06/08/2026 |
Common Stock |
1,282,051 |
$1
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0 |
D
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Warrant (Right to Buy) |
$0.232
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01/27/2020 |
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A
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1,282,051 |
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06/08/2026 |
Common Stock |
1,282,051 |
$1
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1,282,051 |
D
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Warrant (Right to Buy) |
$0.232
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01/29/2020 |
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M |
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2,093,750 |
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10/31/2025 |
Common Stock |
2,093,750 |
$0.00
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0 |
D
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Warrant (Right to Buy) |
$0.232
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01/29/2020 |
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M |
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1,282,051 |
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05/14/2026 |
Common Stock |
1,282,051 |
$1
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0 |
D
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Warrant (Right to Buy) |
$0.232
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01/29/2020 |
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M |
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1,282,051 |
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06/08/2026 |
Common Stock |
1,282,051 |
$1
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0 |
D
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1. Name and Address of Reporting Person*
36 ROBINSON ROAD |
#13-01 CITY HOUSE |
(Street)
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1. Name and Address of Reporting Person*
#30, 1ST MAIN |
J.P. NAGAR 3RD PHASE |
(Street)
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1. Name and Address of Reporting Person*
7TH CIRCLE, ZAHRAN STREET |
ZAHRAN PLAZA BLDG, 4TH FLOOR |
(Street)
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Explanation of Responses: |
Remarks: |
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/s/ BioLexis Pte. Ltd., By: Lawrence Kenyon, Attorney-in-Fact |
01/29/2020 |
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/s/ Lawrence Kenyon, Attorney-in-Fact |
01/29/2020 |
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/s/ Lawrence Kenyon, Attorney-in-Fact |
01/29/2020 |
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** 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
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). |
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. |
POWER OF ATTORNEY
(For Executing Form ID and Forms 3, 4 and 5 and Schedules 13D and 13G)
Know all by these presents, that the undersigned hereby constitutes and
appoints each of Lawrence Kenyon of Outlook Therapeutics, Inc. (the "Company")
and Yezan Haddadin, each a director of the Company, signing individually, the
undersigned's true and lawful attorneys-in fact and agents to:
(1) Prepare, execute in the undersigned's name and on the undersigned's behalf,
and submit to the Securities and Exchange Commission (the "SEC") Form ID and
Forms 3, 4 and 5 (including amendments thereto and joint filing agreements in
connection therewith) in accordance with Section 13 or Section 16 of the
Securities Exchange Act of 1934, as amended (the "Exchange Act") and the rules
thereunder in the undersigned's capacity as a beneficial owner of a registered
class of securities of the Company;
(2) Do and perform any and all acts for and on behalf of the undersigned that
may be necessary or desirable to prepare and execute any such Form ID and Forms
3, 4 or 5, Schedules 13D and 13G (including amendments thereto and joint filing
agreements in connection therewith) and Forms 144, and file such forms with the
SEC and any stock exchange, self-regulatory association or any similar
authority; and
(3) Take any other action of any type whatsoever in connection with the
foregoing that, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required of the undersigned, it being
understood that the documents executed by the attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as the attorney-in-fact may approve in the
attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney in fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney in fact, or such attorney
in fact's substitute or substitutes, shall lawfully do or cause to be done by
virtue of this power of attorney and the rights and powers herein granted. The
undersigned acknowledges that the foregoing attorneys-in-fact, and their
substitutes, in serving in such capacity at the request of the undersigned, are
not assuming (nor is the Company assuming) any of the undersigned's
responsibilities to comply with Sections 13 and 16 of the Exchange Act and Rule
144 thereunder.
This Power of Attorney shall remain in full force and effect until the earliest
to occur of (a) the undersigned is no longer required to file Form ID or Forms
3, 4 and 5 or Schedules 13D or 13G with respect to the undersigned's holdings of
and transactions in securities issued by the Company, (b) revocation by the
undersigned in a signed writing delivered to the Company and the foregoing
attorneys-in fact or (c) as to any attorney-in-fact individually, until such
attorney-in-fact is no longer employed by the Company or a director of the
Company.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of the date written below.
Date: December 30, 2019
BioLexis Pte Ltd.
By: /s/ Faisal G. Sukhtian
Name: Faisal G. Sukhtian
Title: Director
POWER OF ATTORNEY
(For Executing Form ID and Forms 3, 4 and 5 and Schedules 13D and 13G)
Know all by these presents, that the undersigned hereby constitutes and
appoints each of Lawrence Kenyon of Outlook Therapeutics, Inc. (the "Company")
and Yezan Haddadin and Faisal G. Sukhtian each a director of the Company,
signing individually, the undersigned's true and lawful attorneys-in fact and
agents to:
(1) Prepare, execute in the undersigned's name and on the undersigned's behalf,
and submit to the Securities and Exchange Commission (the "SEC") Form ID and
Forms 3, 4 and 5 (including amendments thereto and joint filing agreements in
connection therewith) in accordance with Section 13 or Section 16 of the
Securities Exchange Act of 1934, as amended (the "Exchange Act") and the rules
thereunder in the undersigned's capacity as a beneficial owner of a registered
class of securities of the Company;
(2) Do and perform any and all acts for and on behalf of the undersigned that
may be necessary or desirable to prepare and execute any such Form ID and Forms
3, 4 or 5, Schedules 13D and 13G (including amendments thereto and joint filing
agreements in connection therewith) and Forms 144, and file such forms with the
SEC and any stock exchange, self-regulatory association or any similar
authority; and
(3) Take any other action of any type whatsoever in connection with the
foregoing that, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required of the undersigned, it being
understood that the documents executed by the attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as the attorney-in-fact may approve in the
attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney in fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney in fact, or such attorney
in fact's substitute or substitutes, shall lawfully do or cause to be done by
virtue of this power of attorney and the rights and powers herein granted. The
undersigned acknowledges that the foregoing attorneys-in-fact, and their
substitutes, in serving in such capacity at the request of the undersigned, are
not assuming (nor is the Company assuming) any of the undersigned's
responsibilities to comply with Sections 13 and 16 of the Exchange Act and Rule
144 thereunder.
This Power of Attorney shall remain in full force and effect until the earliest
to occur of (a) the undersigned is no longer required to file Form ID or Forms
3, 4 and 5 or Schedules 13D or 13G with respect to the undersigned's holdings of
and transactions in securities issued by the Company, (b) revocation by the
undersigned in a signed writing delivered to the Company and the foregoing
attorneys-in fact or (c) as to any attorney-in-fact individually, until such
attorney-in-fact is no longer employed by the Company or a director of the
Company.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of the date written below.
Date: December 30, 2019
By: /s/ Ghiath M. Sukhtian
Name: Ghiath M. Sukhtian
POWER OF ATTORNEY
(For Executing Form ID and Forms 3, 4 and 5 and Schedules 13D and 13G)
Know all by these presents, that the undersigned hereby constitutes and
appoints each of Lawrence Kenyon of Outlook Therapeutics, Inc. (the "Company")
and Yezan Haddadin and Faisal G. Sukhtian each a director of the Company,
signing individually, the undersigned's true and lawful attorneys-in fact and
agents to:
(1) Prepare, execute in the undersigned's name and on the undersigned's behalf,
and submit to the Securities and Exchange Commission (the "SEC") Form ID and
Forms 3, 4 and 5 (including amendments thereto and joint filing agreements in
connection therewith) in accordance with Section 13 or Section 16 of the
Securities Exchange Act of 1934, as amended (the "Exchange Act") and the rules
thereunder in the undersigned's capacity as a beneficial owner of a registered
class of securities of the Company;
(2) Do and perform any and all acts for and on behalf of the undersigned that
may be necessary or desirable to prepare and execute any such Form ID and Forms
3, 4 or 5, Schedules 13D and 13G (including amendments thereto and joint filing
agreements in connection therewith) and Forms 144, and file such forms with the
SEC and any stock exchange, self-regulatory association or any similar
authority; and
(3) Take any other action of any type whatsoever in connection with the
foregoing that, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required of the undersigned, it being
understood that the documents executed by the attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as the attorney-in-fact may approve in the
attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney in fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney in fact, or such attorney
in fact's substitute or substitutes, shall lawfully do or cause to be done by
virtue of this power of attorney and the rights and powers herein granted. The
undersigned acknowledges that the foregoing attorneys-in-fact, and their
substitutes, in serving in such capacity at the request of the undersigned, are
not assuming (nor is the Company assuming) any of the undersigned's
responsibilities to comply with Sections 13 and 16 of the Exchange Act and Rule
144 thereunder.
This Power of Attorney shall remain in full force and effect until the earliest
to occur of (a) the undersigned is no longer required to file Form ID or Forms
3, 4 and 5 or Schedules 13D or 13G with respect to the undersigned's holdings of
and transactions in securities issued by the Company, (b) revocation by the
undersigned in a signed writing delivered to the Company and the foregoing
attorneys-in fact or (c) as to any attorney-in-fact individually, until such
attorney-in-fact is no longer employed by the Company or a director of the
Company.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of the date written below.
Date: December 30, 2019
By:/s/ Arun Kumar Pillai
Name: Arun Kumar Pillai