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*
Pitukcheewanont Pisit Duke

(Last) (First) (Middle)
4200 MARATHON BLVD
SUITE 200

(Street)
AUSTIN TX 78756

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/04/2024
3. Issuer Name and Ticker or Trading Symbol
LUMOS PHARMA, INC. [ (LUMO) ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Medical Officer
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)
Common Stock 10,930(1)(2) D
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)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to Buy) 06/01/2023(3) 06/01/2032 Common Stock 29,750 7.69 D
Stock Option (Right to Buy) 02/01/2024(3) 02/01/2033 Common Stock 3,333 3.52 D
Stock Option (Right to Buy) 07/01/2024(3) 07/01/2033 Common Stock 25,500 3.3 D
Explanation of Responses:
1. Includes 3,938 Restricted Stock Units ("RSUs") granted under the Issuers 2009 Equity Incentive Plan (the "Plan"). The RSUs will vest, and shares will be delivered to the Reporting Person in a series of three successive annual installments with the next installment occurring on June 1, 2024, provided in each case that the Reporting Person's continuous service to the Issuer has not been terminated as defined in or as determined under the Plan.
2. Includes 4,500 RSUs granted under the Plan. The RSUs will vest, and shares will be delivered to the Reporting Person in a series of four successive annual installments with the next installment occurring on July 1, 2024, provided in each case that the Reporting Person's continuous service to the Issuer has not been terminated as defined in or as determined under the Plan.
3. The shares subject to the option vests over a four-year period, with 25% of such option vesting on the one-year anniversary of the vesting commencement date and the remaining 75% of such option vesting in equal monthly installments over the next 36 months, provided that at the relevant vesting dates the Reporting Person's continuous service to the Issuer has not been terminated as defined in or as determined under the Plan.
Remarks:
/s/ Ryan Trytten, attorney-in-fact 01/10/2024
** 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.
lumos-formidxpowerofatto
POWER OF ATTORNEY The undersigned hereby constitutes and appoints Brad Powers, General Counsel and/or Ryan Trytten, Manager of SEC Reporting, the undersigned’s true and lawful attorney-in-fact to: 1. Prepare, execute on behalf of the undersigned, and submit to the U.S. Securities and Exchange Commission (the “SEC”) any documents necessary or advisable to obtain EDGAR access codes enabling the undersigned to make electronic filings of reports with the SEC; and 2. Take any other action of any type whatsoever in connection with the foregoing which, in the opinion of the attorney-in-fact, may be legally required or in the best interest of the undersigned, it being understood that any documents executed by the attorney-in-fact on behalf of the undersigned pursuant to this power of attorney shall be in such form and contain such terms and conditions as the attorney-in-fact may approve in the attorney-in-fact’s discretion. The undersigned hereby grants to the attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever necessary or advisable to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that the attorney-in-fact, or the attorney-in-fact’s substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. IN WITNESS WHEREOF, the undersigned has executed this power of attorney on the 19th day of December, 2023. Pisit “Duke” Pitukcheewanont DocuSign Envelope ID: 74AEE042-6EB5-4430-B729-6FA6977E9BB6