SEC FORM 3

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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^*

Bruck Claudine

(Last)

(First)

(Middle)

C/O ANNOVIS BIO, INC.

1055 WESTLAKES DRIVE, SUITE 300

(Street)

BERWYN

19312

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
01/28/2020

3. Issuer Name and Ticker or Trading Symbol
Annovis Bio, Inc. [ ANVS ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
	Officer (give title below)	Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
Convertible Note	⁽¹⁾	⁽¹⁾	Common Stock	⁽¹⁾	⁽¹⁾	D
Series A-1 Preferred Stock	⁽²⁾	⁽²⁾	Common Stock	5,556	⁽²⁾	D
Stock Option (right to buy)	⁽³⁾	04/06/2028	Common Stock	24,997	$0.14	D
Stock Option (right to buy)	⁽³⁾	04/07/2026	Common Stock	7,142	$0.25	D

Explanation of Responses:

1. The Convertible Notes have a maturity date of December 31, 2023. Prior to the maturity date, the Convertible Notes will automatically convert into common stock of Annovis Bio, Inc. ("Annovis") upon an initial public offering ("IPO") of Annovis at a conversion rate equal to the principal amount of the note, plus accrued and unpaid interest, divided by 80% of the public offering price per share of the IPO as set forth on the cover page of the final prospectus for the IPO.

2. Each share of Series A-1 Preferred Stock is convertible into common stock of Annovis and has no expiration date. Upon the closing of the IPO, 7,778 shares of Series A-1 Preferred Stock, along with the aggregate accrued or accumulated and unpaid dividends thereon, will automatically be converted into 5,556 shares of common stock of the Issuer.

3. As of the date of this report, all of the shares underlying the options are fully vested and exercisable.

	/s/ Maria Maccecchini Attorney-in-Fact	01/29/2020
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations 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 is insufficient, see Instruction 6 for procedure.
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 Number.