0001104659-20-008249 3 1 20200128 20200129 20200129 Bruck Claudine 0001733680 3 34 001-39202 20559537 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 3 1 a3.xml 3 FORM 3 OMB APPROVAL UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB Number: Washington, D.C. 20549 3235-0104 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF Estimated SECURITIES average burden hours per response... 0.5 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. Date of Event 3. Issuer Name and Ticker or Trading Person * Requiring Symbol Bruck Claudine Statement Annovis Bio, Inc. [ANVS] (MM/DD/YYYY) 1/28/2020 (Last) (First) (Middle) 4. Relationship of Reporting Person(s) to Issuer (Check C/O ANNOVIS BIO, INC., 1055 all applicable) WESTLAKES DRIVE, SUITE 300 __X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below) (Street) 5. If Amendment, 6. Individual or Joint/Group BERWYN, PA 19312 Date Original Filing(Check Applicable Line) (City) (State) (Zip) Filed(MM/DD/YYYY) _X_ Form filed by One Reporting Person ___ Form filed by More than One Reporting Person Table I - Non-Derivative Securities Beneficially Owned 1.Title of Security 2. Amount of 3. 4. Nature of Indirect (Instr. 4) Securities Ownership Beneficial Ownership Beneficially Form: (Instr. 5) Owned Direct (Instr. 4) (D) or Indirect (I) (Instr. 5) Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 1. Title of Derivate Security 2. Date Exercisable 3. Title and 4. 5. 6. Nature of (Instr. 4) and Expiration Date Amount of Conversion Ownership Indirect (MM/DD/YYYY) Securities or Form of Beneficial Underlying Exercise Derivative Ownership Derivative Price of Security: (Instr. 5) Security Derivative Direct (D) (Instr. 4) Security or Indirect (I) Date Expiration Title Amount (Instr. 5) Exercisable Date or Number of Shares Convertible Note (1) (1) Common (1) (1) D Stock Series A-1 Preferred Stock (2) (2) Common 5556 (2) D Stock Stock Option (right to buy) (3) 4/6/2028 Common 24997 $0.14 D Stock Stock Option (right to buy) (3) 4/7/2026 Common 7142 $0.25 D Stock Explanation of Responses: (1) The Convertible Notes have a maturity date of December 31, 2023. Prior to the maturity date, the Convertible Notes will automatically convert into common stock of Annovis Bio, Inc. ("Annovis") upon an initial public offering ("IPO") of Annovis at a conversion rate equal to the principal amount of the note, plus accrued and unpaid interest, divided by 80% of the public offering price per share of the IPO as set forth on the cover page of the final prospectus for the IPO. (2) Each share of Series A-1 Preferred Stock is convertible into common stock of Annovis and has no expiration date. Upon the closing of the IPO, 7,778 shares of Series A-1 Preferred Stock, along with the aggregate accrued or accumulated and unpaid dividends thereon, will automatically be converted into 5,556 shares of common stock of the Issuer. (3) As of the date of this report, all of the shares underlying the options are fully vested and exercisable. 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/ Maria Maccecchini Attorney-in-Fact 1/29/2020 ** 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 5(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.