Statement of Changes in Beneficial Ownership (4)
May 03 2017 - 6:19PM
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
*
Hakim Nasrat A
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2. Issuer Name
and
Ticker or Trading Symbol
ELITE PHARMACEUTICALS INC /NV/
[
ELTP
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
CEO & President
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(Last)
(First)
(Middle)
C/O ELITE PHARMACEUTICALS, INC., 165 LUDLOW AVE.
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3. Date of Earliest Transaction
(MM/DD/YYYY)
4/28/2017
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(Street)
NORTHVALE, NJ 07647
(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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4/28/2017
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J
(1)
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158017321
(1)
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D
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(1)
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9097561
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D
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Common Stock
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2700000
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I
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by IRA
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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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Series J Convertible Preferred Shares
(1)
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$1000000
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4/28/2017
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J
(1)
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24.0344
(2)
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(3)
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(4)
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Common Stock
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158017321
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$1000000
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24.0344
(2)
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D
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Warrants
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$0.1521
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4/28/2017
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J
(1)
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79008661
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(3)
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4/28/2027
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Common Stock
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79008661
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$0
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79008661
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D
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Explanation of Responses:
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(1)
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The common shares were returned to the company in exchange for the Series J Convertible Preferred Shares and warrants issued by the company.
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(2)
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The preferred shares are convertible into shares of common stock at a rate of 6,576,878.18 shares of common stock for each whole share of preferred stock.
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(3)
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The date that Shareholder Approval is obtained for an increase in the number of authorized shares of common stock to permit full conversion of the preferred stock and exercise of the warrants.
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(4)
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None.
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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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Hakim Nasrat A
C/O ELITE PHARMACEUTICALS, INC.
165 LUDLOW AVE.
NORTHVALE, NJ 07647
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X
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X
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CEO & President
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Signatures
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Nasrat Hakim
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5/3/2017
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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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