SEC Form 4 · accession 0000899243-16-030260
Novan, Inc. · NOVN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
John W Palmour
Director
Period of report
Sep 26, 2016
Accepted (ET)
Sep 28, 2016 · 6:27 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001467154
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Sep 26, 2016 | C | 241,568 | $0.00 | A | 241,568 | D | |
| Common Stock | Sep 26, 2016 | C | 274,875 | $0.00 | A | 274,875 | I | By Palmour 2012 Irrevocable Children's Trust |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series 3 Preferred StockF1 | — | Sep 26, 2016 | C | 34,359 | D | — | — | Common Stock | 34,359 | 0 | D |
| Series 3 Preferred StockF1 | — | Sep 26, 2016 | C | 274,875 | D | — | — | Common Stock | 274,875 | 0 | I |
| Series 4 Preferred StockF1 | — | Sep 26, 2016 | C | 152,778 | D | — | — | Common Stock | 152,778 | 0 | D |
| Mezzanine A StockF1 | — | Sep 26, 2016 | C | 44,976 | D | — | — | Common Stock | 44,976 | 0 | D |
| Mezzanine B StockF1 | — | Sep 26, 2016 | C | 9,455 | D | — | — | Common Stock | 9,455 | 0 | D |
Explanation of responses
- F1The preferred stock automatically converted into common stock on a 1-to-1 basis upon the closing of the Issuer's initial public offering.