Statement of Changes in Beneficial Ownership (4)
June 01 2020 - 5:11PM
Edgar (US Regulatory)
FORM 4
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
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BORKOWSKI EDWARD |
2. Issuer Name and Ticker or Trading Symbol
AzurRx BioPharma, Inc.
[
AZRX
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O AZURRX BIOPHARMA, INC., 760 PARKSIDE AVE SUITE 304 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/1/2020 |
(Street)
BROOKLYN, NY 11226
(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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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) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
9.0% Senior Convertible Promissory Note (1) | $0.97 | 6/1/2020 | | D | | | $100000 | 12/20/2019 | 9/20/2020 | Common Stock | 103093 (2) | $100000 | 0 | D | |
9.0% Senior Convertible Promissory Note (1) | $1.07 | 6/1/2020 | | A | | $100000 | | 12/20/2019 | 9/20/2020 | Common Stock | 93458 (3) | $100000 | $100000 | D | |
Explanation of Responses: |
(1) | On June 1, 2020, AzurRx Biopharma, Inc. (the "Company") and Edward Borkowski amended the Senior Convertible Promissory Note (the "Note") previously issued on December 20, 2019 to increase the conversion price from $0.97 per share to $1.07 per share. |
(2) | Represents the number of shares of the Company's common stock, par value $0.001 per share ("Common Stock") issuable upon conversion of the principal amount of the Note at the original conversion price of $0.97 per share. |
(3) | Represents the number of shares of Common Stock issuable upon conversion of the principal amount of the Note at the amended conversion price of $1.07 per share. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
BORKOWSKI EDWARD C/O AZURRX BIOPHARMA, INC. 760 PARKSIDE AVE SUITE 304 BROOKLYN, NY 11226 | X |
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Signatures
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/s/ Ed Borkowski | | 6/1/2020 |
**Signature of Reporting Person | Date |
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