0001104659-20-010940 4 1 20200131 20200205 20200205 Bruck Claudine 0001733680 4 34 001-39202 20576282 4995 BRADENTON AVE, SUITE 240 DUBLIN OH 43017-3552 Annovis Bio, Inc. 0001477845 2834 262540421 DE 1231 1055 WESTLAKES DRIVE, SUITE 300 BERWYN PA 19312 610-727-3913 1055 WESTLAKES DRIVE, SUITE 300 BERWYN PA 19312 QR Pharma, Inc. 20091202 4 1 a4.xml 4 FORM 4 OMB APPROVAL [ ] Check this OMB Number: box if no longer UNITED STATES SECURITIES AND EXCHANGE COMMISSION 3235-0287 subject to Washington, D.C. 20549 Estimated Section 16. Form STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF average burden 4 or Form 5 SECURITIES hours per obligations may response... 0.5 continue. See Instruction 1(b). Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 1. Name and Address of Reporting 2. Issuer Name and Ticker 5. Relationship of Person * or Trading Symbol Reporting Person(s) to Bruck Claudine Annovis Bio, Inc. [ ANVS ] Issuer (Check all applicable) __X__ Director _____ (Last) (First) (Middle) 3. Date of Earliest 10% Owner C/O ANNOVIS BIO, INC., 1055 Transaction (MM/DD/YYYY) _____ Officer (give title WESTLAKES DRIVE, SUITE 300 1/31/2020 below) _____ Other (specify below) (Street) 4. If Amendment, Date 6. Individual or BERWYN, PA 19312 Original Filed Joint/Group Filing (Check (City) (State) (Zip) (MM/DD/YYYY) Applicable Line) _X _ Form filed by One Reporting Person ___ Form filed by More than One Reporting Person Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1.Title of Security 2. Trans. Date 2A. 3. Trans. 4. Securities Acquired (A) or Disposed 5. Amount of 6. Ownership 7. Nature of (Instr. 3) Deemed Code of (D) Securities Form: Direct (D) Indirect Execution (Instr. 8) (Instr. 3, 4 and 5) Beneficially or Indirect (I) Beneficial Date, if Owned Following (Instr. 4) Ownership any Reported (Instr. 4) Transaction(s) (A) (Instr. 3 and 4) or Code V Amount (D) Price Common Stock 1/31/2020 P 800 (1) A $6.00 800 D Common Stock 1/31/2020 C 3969 A (2) 4769 D Common Stock 1/31/2020 C 1117 A $4.80 (3) 5886 D Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 1. Title of 2. 3. Trans. Date 3A. 4. Trans. 5. Number of Derivative 6. Date Exercisable 7. Title and Amount of 8. Price 9. Number of 10. 11. Nature Derivate Security Conversion Deemed Code Securities Acquired (A) or and Expiration Date Securities Underlying of derivative Ownership of (Instr. 3) or Execution (Instr. 8) Disposed of (D) Derivative Security Derivative Securities Form of Indirect Exercise Date, if (Instr. 3, 4 and 5) (Instr. 3 and 4) Security Beneficially Derivative Beneficial Price of any (Instr. 5) Owned Security: Ownership Derivative Following Direct (D) (Instr. 4) Security Reported or Transaction(s) Indirect Date Expiration Amount or (Instr. 4) (I) Exercisable Date Title Number of (Instr. 4) Code V (A) (D) Shares Series A-1 (2) 1/31/2020 C 5556 (2) (2) Common 3969 $0 0 D Preferred Stock Stock Convertible Note (3) 1/31/2020 C 1117 (3) (3) (3) Common 1117 $4.80 0 D Stock Explanation of Responses: (1) The reporting person acquired these shares in the initial public offering ("IPO") of Annovis Bio, Inc. ("Annovis"). (2) Each share of Series A-1 Preferred Stock automatically converted into common stock of Annovis upon the closing of the IPO at a conversion ratio of one for 0.7143. (3) The convertible notes have a maturity date of December 31, 2023. The Convertible Notes automatically converted into common stock of Annovis upon the closing of the IPO at a conversion rate equal to the principal amount of the note, plus accrued and unpaid interest, divided by $4.80 (80% of the IPO price). Reporting Owners Reporting Owner Name / Address Relationships Director 10% Owner Officer Other Bruck Claudine C/O ANNOVIS BIO, INC. X 1055 WESTLAKES DRIVE, SUITE 300 BERWYN, PA 19312 Signatures /s/ Claudine Bruck 2/4/2020 ** 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 control number.