Statement of Changes in Beneficial Ownership (4)
03 June 2019 - 10:01PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
Madan Jay P.
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2. Issuer Name
and
Ticker or Trading Symbol
INNOVATE BIOPHARMACEUTICALS, INC.
[
INNT
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
President
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(Last)
(First)
(Middle)
C/O INNOVATE BIOPHARMACEUTICALS, INC.,, 8480 HONEYCUTT ROAD, SUITE 120
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3. Date of Earliest Transaction
(MM/DD/YYYY)
5/30/2019
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(Street)
RALEIGH, NC 27615
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. 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
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V
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Amount
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(A) or (D)
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Price
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Common stock
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5/30/2019
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P
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5000
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A
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$1.32
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84131
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D
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Common stock
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129593
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I
(1)
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By Madan Global, Inc.
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Common stock
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122104
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I
(2)
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By OM Healthcare Partners LLC
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Common stock
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122104
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I
(3)
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By OM Healthcare Partners II LLC
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Common stock
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122104
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I
(4)
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By OM Healthcare Partners III LLC
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Common stock
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450000
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I
(5)
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By MGI Holdings II LLC
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. 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
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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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(1)
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These shares are held by Madan Global, Inc. Mr. Madan is the sole owner of Madan Global, Inc. and has voting and investment power over the shares held by Madan Global, Inc.
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(2)
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These shares are held by OM Healthcare Partners LLC. Mr. Madan is the sole owner and manager of OM Healthcare Partners LLC and has voting and investment power over the shares held by OM Healthcare Partners LLC.
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(3)
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These shares are held by OM Healthcare Partners II LLC. Mr. Madan is the sole owner and manager of OM Healthcare Partners II LLC and has voting and investment power over the shares held by OM Healthcare Partners II LLC.
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(4)
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These shares are held by OM Healthcare Partners III LLC. Mr. Madan is the sole owner and manager of OM Healthcare Partners III LLC and has voting and investment power over the shares held by OM Healthcare Partners III LLC.
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(5)
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These shares are held by MGI Holdings II LLC. Mr. Madan is the sole owner and manager of MGI Holdings II LLC and has voting and investment power over the shares held by MGI Holdings II LLC.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Madan Jay P.
C/O INNOVATE BIOPHARMACEUTICALS, INC.,
8480 HONEYCUTT ROAD, SUITE 120
RALEIGH, NC 27615
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X
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President
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Signatures
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/s/ Kendyle Woodard, as Attorney-in-Fact
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6/3/2019
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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