George Cappy - 02 Aug 2023 Form 4 Insider Report for MIRA PHARMACEUTICALS, INC. (MIRA)

Role
10%+ Owner
Signature
/s/ Michelle Yanez, Attorney-in-Fact for George Cappy
Issuer symbol
MIRA
Transactions as of
02 Aug 2023
Net transactions value
+$1,100,190
Form type
4
Filing time
04 Aug 2023, 13:42:39 UTC
Next filing
24 Aug 2023

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
transaction MIRA Common Stock Purchase $1,100,190 +157,170 +6.1% $7.00 2,740,270 02 Aug 2023 By Trust F1, F2
holding MIRA Common Stock 20,000 02 Aug 2023 Direct F3

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Underlying Class Amount Exercise Price Ownership Footnotes
holding MIRA Common Stock Warrant (right to buy) 1,000,000 02 Aug 2023 Common Stock 1,000,000 $5.00 By Trust F2
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 Represents the acquisition of shares of common stock by the Bay Shore Trust (the "Trust") through the conversion of an aggregate of $1,100,190 of indebtedness owing by the Issuer to the Trust, with such conversion occurring on the date of the Issuer's initial public offering at a conversion price of $7.00 per share.
F2 These securities are owned directly by the Trust, a greater-than-10% owner of the Issuer. As sole trustee of the Trust, George Cappy ("Mr. Cappy") has sole ownership and dispositive power over these securities and is therefore deemed to be an indirect beneficial owner of the securities for purposes of SEC Rule 13d-3, although Mr. Cappy disclaims beneficial ownership of the reported securities due to the absence of any pecuniary interest therein.
F3 These securities are owned directly by Mr. Cappy.