Initial Statement of Beneficial Ownership (3)
November 12 2021 - 11:02AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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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Breen Michael Martin |
2. Date of Event Requiring Statement (MM/DD/YYYY)
1/13/2021
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3. Issuer Name and Ticker or Trading Symbol
GT Biopharma, Inc. [GTBP]
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(Last)
(First)
(Middle)
C/O GT BIOPHARMA, INC., 9350 WILSHIRE BLVD., STE. 203 |
4. 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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(Street)
BEVERLY HILLS, CA 90212
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 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 Beneficially Owned
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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)
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1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5) | 6. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| 10% Senior Convertible Debenture | 9/7/2018 | (1) | Common Stock | (1) | $3.40 (1) | D | |
| 10% Senior Convertible Debenture | 6/23/2020 | 6/23/2021 | Common Stock | (2) | $3.40 (2) | D | |
| Explanation of Responses: |
| (1) | Reflects a 10% Senior Convertible Debenture in the face amount of $100,000. While the maturity date of the Debenture was September 7, 2019, the Registrant did not repay the Debenture on the maturity date and the Debenture remained outstanding. Per the provisions of the Debenture, outstanding principal and interest were convertible at a per share price of $3.40 (which reflects the applicable conversion price on a post-reverse split basis). |
| (2) | Reflects a 10% Senior Convertible Debenture in the face amount of $30,000. Per the provisions of the Debenture, outstanding principal and interest were convertible at a per share price of $3.40 (which reflects the applicable conversion price on a post-reverse split basis) |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Breen Michael Martin
C/O GT BIOPHARMA, INC.
9350 WILSHIRE BLVD., STE. 203
BEVERLY HILLS, CA 90212 | X |
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Signatures
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| /s/ Michael Martin Bree | | 11/9/2021 |
| **Signature of Reporting Person | Date |
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