SEC Filing | Windtree Therapeutics, Inc

View:

U.S. SECURITIES AND EXCHANGE OMB APPROVAL FORM 3 Washington, D.C. 20549 ------------------------- OMB Number: Expires: INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Estimated average burden hours per response...0.5 Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 20(f) of the Investment Company Act of 1949 1. Name and Address of Reporting Person 2. Date of Event 4. Issuer Name and Ticker or Trading Symbol Requiring Discovery Laboratories, Inc. Statement Ansan Phamaceuticals, Inc. ("Ansan") ========================================== (Month/Day/Year) (Last) (First) (Middle) ANSN 509 Madison Avenue, 14th Floor 7/16/97 ========================================== ---------------------------------------------------------------------------------------- (Street) 5. Relationship of Reporting Person to Issuer 6. If Amendment, 3. IRS or Social (Check all applicable) Date of Original New York, NY 10022 Security Number (Month/Day/Year) ========================================== of Reporting ___Director [X] 10% Owner (City) (State) (Zip Code) Person Officer (give ___ Other (specify) (Voluntary) title below) =================== -------------------------------------------------------------------- TABLE I--NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect Beneficial (Instr. 4) Beneficially Owned Direct (D) or Ownership (Instr. 5) (Instr. 4) Indirect (I) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ N/A - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Page 1 of 2

TABLE II--DERIVATIVE SECURITIES BENEFICIALLY OWNED (e.g., puts, calls, warrants, options, convertible securities) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date 3. Title and Amount 4. 5. Ownership 6. Nature of Indirect Beneficial (Instr. 4) Exercisable and of Securities Conversion Form of Ownership (Instr. 5) Expiration Date Underlying or Exercise Derivative (Month/Day/ Derivative Security Price of Security: Year) (Instr. 4) Derivative Direct (D) or Security Indirect (I) (Instr. 5) -------------------------------------- Date Expir- Title Amount Exerci- ation or sable Date Number of Shares - ------------------------------------------------------------------------------------------------------------------------------------ Series A Convertible Preferred Common Stock 7/16/97 N/A Stock(1) 928,571 $1.40(1) D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (1) The Series A Convertible Preferred Stock is convertible into shares of Common Stock at a conversion rate determined by dividing a stated price of $100 per share of Series A Convertible Preferred Stock by a conversion price of $1.40 per share, which conversion price is subject to adjustment as set forth in the Certificate of Designations for the Series A Convertible Preferred Stock. Such conversion price shall also be adjusted upon the occurrence of certain reset events upon which the conversion price shall be equal to the price necessary for the Series A Convertible Preferred Stock to have 51% of Ansan's voting rights and to be convertible into 51% of Ansan's issued and outstanding shares of Common Stock on a fully diluted basis (excluding certain outstanding warrants). ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ James S. Kuo, President and CEO on behalf of Discovery Laboratories, Inc. July 25, 1997 ----------------------------------------- ------------- **Signature of Reporting Person Date 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 provided is insufficient, See Instruction 6 for procedure. ___________________________ Page 2 of 2