Initial Statement of Beneficial Ownership (3)
March 30 2020 - 6:33PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
*
Hawkins Richard J |
2. Date of Event Requiring Statement (MM/DD/YYYY)
3/18/2020
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3. Issuer Name and Ticker or Trading Symbol
LUMOS PHARMA, INC. [(LUMO)]
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(Last)
(First)
(Middle)
4200 MARATHON BLVD, SUITE 200 |
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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(Street)
AUSTIN, TX 78756
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 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 | 719575 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
| Stock Option (Right to Buy) | 6/27/2019 (1) | 6/27/2029 | Common Stock | 19624.0 | $1.84 | D | |
| Explanation of Responses: |
| (1) | The shares subject to the option vest and become exercisable in 48 substantially equal monthly installments beginning on December 7, 2018, subject to the reporting person's continued service with the Issuer and subject to acceleration upon the occurrence of certain events. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Hawkins Richard J
4200 MARATHON BLVD
SUITE 200
AUSTIN, TX 78756 | X |
| Chief Executive Officer |
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Signatures
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| /s/ Ryan Trytten, attorney-in-fact | | 3/30/2020 |
| **Signature of Reporting Person | Date |
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