SEC Form 4 · accession 0001214659-17-007033

NEXIEN BIOPHARMA, INC. · NXEN

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Officer — Chief Executive Officer · Director · 10% Owner

Period of report

Nov 29, 2017

Accepted (ET)

Nov 30, 2017 · 2:54 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001625288

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F2	Nov 29, 2017	J	15,099,083	—	A	24,000,000	I	By Intiva USA Inc.
Common Stock^F1,F3	Nov 29, 2017	J	1,258,257	—	A	2,000,000	D
Common Stock^F1,F4	Nov 29, 2017	J	130,859	—	A	208,000	I	By Lane 6552 LLC

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Class A Warrants (right to buy)^F5	$0.25	Nov 29, 2017	J	20,800	A	Nov 29, 2017	Jan 31, 2018	Common Stock	20,800	20,800	I
Class B Warrants (right to buy)^F6	$0.375	Nov 29, 2017	J	20,800	A	Nov 29, 2017	May 7, 2018	Common Stock	20,800	20,800	I
Class C Warrants (right to buy)^F7	$0.50	Nov 29, 2017	J	20,800	A	Nov 29, 2017	Jul 14, 2018	Common Stock	20,800	20,800	I

F1As adjusted to reflect a one-for-six reverse split of the issuer's common stock effective November 29, 2017
F2Acquired in exchange for all of Intiva USA's shares of Intiva BioPharma Inc.
F3Acquired in exchange for all of Jeffrey Friedland's shares of Intiva BioPharma Inc.
F4Acquired in exchange for all of Lane 6552 LLC's shares of Intiva BioPharma Inc.
F5Acquired in exchange for all of Lane 6552 LLC's Class A warrants of Intiva BioPharma Inc.
F6Acquired in exchange for all of Lane 6552 LLC's Class B warrants of Intiva BioPharma Inc.
F7Acquired in exchange for all of Lane 6552 LLC's Class C warrants of Intiva BioPharma Inc.