Insider filing report for Changes in Beneficial Ownership
- Schedule 13G & 13D forms are used to report a party's ownership of stock which exceeds 5% of a company's total stock issue.
- Schedule 13G is a shorter version of Schedule 13D with fewer reporting requirements.
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UNITED
STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE
13G
UNDER THE SECURITIES EXCHANGE ACT OF 1934
(Amendment No. 1)
Lixte Biotechnology Holdings, Inc.
(Name of Issuer)
Common Stock, $0.0001 par value per share
(Title of Class of Securities)
539319 202
(CUSIP Number)
November 30, 2020
(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
[ ] Rule 13d-1(b)
[X] Rule 13d-1(c)
[ ] Rule 13d-1(d)
*The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall not be subject to all other provisions of the Act (however, see the Notes).
CUSIP NO. 539319 10 3 |
Page 2 of 5 Pages |
| 1. | NAMES OF REPORTING PERSONS. | |
| Eric Forman | ||
| 2. | CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP | (a) [ ] |
| (b) [X] | ||
| 3. | SEC USE ONLY | |
| 4. | CITIZENSHIP OR PLACE OF ORGANIZATION | |
| United States | ||
| NUMBER OF | 5. | SOLE VOTING POWER | 1,416,583(1) |
| SHARES | |||
| BENEFICIALLY | 6. | SHARED VOTING POWER | |
| OWNED BY | |||
| EACH | 7. | SOLE DISPOSITIVE POWER | 1,416,583(1) |
| REPORTING | |||
| PERSON WITH | 8. | SHARED DISPOSITIVE POWER |
| 9. | AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON. | |
| 1,417.916(1) | ||
| 10. | CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES | |
| CERTAIN SHARES | [ ] | |
| 11. | PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)2 | |
| 11.38% | ||
| 12. | TYPE OF REPORTING PERSON | |
| IN | ||
1 Consists of (a) 1,333,333 shares of common stock held by the John and Barbara Kovach 2015 Trust of which Mr. Forman is the sole trustee and, (b) 16,667 shares of Common Stock and options to purchase 64,583 shares of Common Stock, owned directly by Mr. Forman.
2 Based on 12,374,302 shares of Common Stock, outstanding as of November 30, 2020.
CUSIP NO. 539319 10 3 |
Page 3 of 5 Pages |
Item 1(a). Name of Issuer.
The name of the issuer is Lixte Biotechnology Holdings, Inc. (the “Issuer”).
Item 1(b). Address of Issuer’s Principal Executive Offices.
The address of the Issuer’s principal executive office is 248 Route 25A, No. 2, East Setauket, New York 11733.
Item 2(a). Name of Person Filing.
Eric Forman
Item 2(b). Address of Principal Business Office, or, if None, Residence.
248 Route 25A, No. 2, East Setauket, New York 11733
Item 2(c). Citizenship.
United States citizen.
Item 2(d). Title of Class of Securities.
The title of the class of securities to which this statement relates is the Common stock, $0.0001 par value per share.
Item 2(e). CUSIP No.
The CUSIP number is 539319-202.
Item 3. If This Statement is Filed Pursuant to Rule 13d-1(b) or 13d-2(b), Check Whether the Person Filing is a:
| (a) | [ ] | Broker or dealer registered under Section 15 of the Act |
| (b) | [ ] | Bank as defined in Section 3(a)(6) of the Act |
| (c) | [ ] | Insurance Company as defined in Section 3(a)(19) of the Act |
| (d) | [ ] | Investment Company registered under Section 8 of the Investment Company Act of 1940 |
| (e) | [ ] | Investment Adviser registered under section 203 of the Investment Advisers Act of 1940 |
| (f) | [ ] | Employee Benefit Plan, Pension Fund which is subject to the provisions of the Employee Retirement Income Security Act of 1974 or Endowment Fund; see Rule 13d-1(b)(1)(ii)(F) |
| (g) | [ ] | Parent Holding Company, in accordance with Rule 13d-1(b)(1)(ii)(G) (Note: See Item 7) |
| (h) | [ ] | Group, in accordance with Rule 13d-1(b)(1)(ii)(H). |
CUSIP NO. 539319 10 3 |
Page 4 of 5 Pages |
Item 4. Ownership.
The information required by Items 4(a) – (c) is set forth in Rows 5 – 11 of the cover pages and is incorporated herein by reference.
Item 5. Ownership of Five Percent or Less of a Class.
Not Applicable.
Item 6. Ownership of More than Five Percent on Behalf of Another Person.
Not Applicable.
Item 7. Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company.
Not Applicable.
Item 8. Identification and Classification of Members of the Group.
Not Applicable.
Item 9. Notice of Dissolution of Group.
Not Applicable.
Item 10. Certifications.
By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect.
CUSIP NO. 539319 10 3 |
Page 5 of 5 Pages |
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
| Dated: December 15, 2020 | |
| /s/ ERIC FORMAN | |
| Eric Forman |