Regulatory Filings • Oct 31, 2023
Regulatory Filings
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL
Washington, D.C. 20549 FORM D
OMB Number: 3235-0076 Estimated average burden hours per response 4.00
| 1. Issuer's Identity | |||||
|---|---|---|---|---|---|
| CIK (Filer ID Number) | Previous Names | None | Entity Type | ||
| 0001614744 Name of Issuer |
Kitov Pharma Ltd. |
X Corporation Limited Partnership |
|||
| PURPLE BIOTECH LTD. | Limited Liability Company | ||||
| Jurisdiction of Incorporation/Organization | General Partnership | ||||
| ISRAEL Year of Incorporation/Organization |
Business Trust | ||||
| X Over Five Years Ago | Other (Specify) | ||||
| Within Last Five Years (Specify Year) | |||||
| Yet to Be Formed | |||||
| 2. Principal Place of Business and Contact Information | |||||
| Name of Issuer | |||||
| PURPLE BIOTECH LTD. | |||||
| Street Address 1 | Street Address 2 | ||||
| 4 OPPENHEIMER STREET | SCIENCE PARK | ||||
| City | State/Province/Country | ZIP/PostalCode | Phone Number of Issuer | ||
| REHOVOT ISRAEL |
7670104 | +972-3-933-3121 | |||
| 3. Related Persons | |||||
| Last Name | First Name | Middle Name | |||
| Efron Street Address 1 |
Gil Street Address 2 |
||||
| 4 Oppenheimer Street | Science Park | ||||
| City | State/Province/Country | ZIP/PostalCode | |||
| Rehovot Relationship: X Executive Officer |
ISRAEL Director |
Promoter | 7670104 | ||
| Clarification of Response (if Necessary): | |||||
| Chief Executive Officer | |||||
| Last Name | First Name | Middle Name | |||
| Fhima | Lior | ||||
| Street Address 1 4 Oppenheimer Street |
Street Address 2 Science Park |
||||
| City | State/Province/Country | ZIP/PostalCode | |||
| Rehovot | ISRAEL | 7670104 | |||
| Relationship: X Executive Officer |
Director | Promoter | |||
| Clarification of Response (if Necessary): | |||||
| Chief Financial Officer | |||||
| Last Name | First Name | Middle Name | |||
| Rowinsky Street Address 1 |
Eric Street Address 2 |
||||
| 4 Oppenheimer Street | Science Park | ||||
| City | State/Province/Country | ZIP/PostalCode | |||
| Rehovot Relationship: Executive Officer |
ISRAEL X Director |
Promoter | 7670104 | ||
| Clarification of Response (if Necessary): | |||||
| Chairman of the Board of Directors | |||||
| Last Name | First Name | Middle Name | |||
| Israel Street Address 1 |
Isaac Street Address 2 |
||||
| 4 Oppenheimer Street | Science Park | ||||
| City | State/Province/Country | ZIP/PostalCode | |||
| Rehovot Relationship: Executive Officer |
ISRAEL X Director |
Promoter | 7670104 |
Clarification of Response (if Necessary):
| Last Name | First Name | Middle Name |
|---|---|---|
| Rock | Simcha | |
| Street Address 1 | Street Address 2 | |
| 4 Oppenheimer Street | Science Park | |
| City | State/Province/Country | ZIP/PostalCode |
| Rehovot | ISRAEL | 7670104 |
| Relationship: Executive Officer |
X Director Promoter |
|
| Clarification of Response (if Necessary): | ||
| Last Name | First Name | Middle Name |
| Agmon | Ido | |
| Street Address 1 | Street Address 2 | |
| 4 Oppenheimer Street | Science Park | |
| City | State/Province/Country | ZIP/PostalCode |
| Rehovot | ISRAEL | 7670104 |
| Relationship: Executive Officer |
X Director Promoter |
|
| Clarification of Response (if Necessary): | ||
| Last Name | First Name | Middle Name |
| Gagnon | Robert | |
| Street Address 1 | Street Address 2 | |
| 4 Oppenheimer Street | Science Park | |
| City | State/Province/Country | ZIP/PostalCode |
| Rehovot | ISRAEL | 7670104 |
| Relationship: Executive Officer |
X Director Promoter |
|
| Clarification of Response (if Necessary): | ||
| Last Name | First Name | Middle Name |
| Nahum-Zilberberg | Suzana | |
| Street Address 1 | Street Address 2 | |
| 4 Oppenheimer Street | Science Park | |
| City | State/Province/Country | ZIP/PostalCode |
| Rehovot | ISRAEL | 7670104 |
| Relationship: Executive Officer |
X Director Promoter |
|
| Clarification of Response (if Necessary): | ||
| Last Name | First Name | Middle Name |
| Hershkovitz | Ori | |
| Street Address 1 | Street Address 2 | |
| 4 Oppenheimer Street | Science Park | |
| City | State/Province/Country | ZIP/PostalCode |
| Rehovot | ISRAEL | 7670104 |
| Relationship: Executive Officer |
X Director Promoter |
|
| Clarification of Response (if Necessary): | ||
| Last Name | First Name | Middle Name |
| Reuveni | Hadas | |
| Street Address 1 | Street Address 2 | |
| 4 Oppenheimer Street | Science Park | |
| City | State/Province/Country | ZIP/PostalCode |
| Rehovot | ISRAEL | 7670104 |
| Relationship: X Executive Officer |
Director Promoter |
|
| Clarification of Response (if Necessary): | ||
| Vice President of Research and Development | ||
| Last Name | First Name | Middle Name |
| Schickler | Michael | |
| Street Address 1 | Street Address 2 | |
| 4 Oppenheimer Street | Science Park |
| City | State/Province/Country | ZIP/PostalCode |
|---|---|---|
| Rehovot Relationship: X Executive Officer |
ISRAEL Director Promoter |
7670104 |
| Clarification of Response (if Necessary): | ||
| Head of Regulatory and Clinical Operations | ||
| Last Name Morpurgo |
First Name Ido |
Middle Name |
| Street Address 1 | Street Address 2 | |
| 4 Oppenheimer Street | Science Park | |
| City Rehovot |
State/Province/Country ISRAEL |
ZIP/PostalCode 7670104 |
| Relationship: X Executive Officer |
Director Promoter |
|
| Clarification of Response (if Necessary): | ||
| Vice President of Operations | ||
| Last Name | First Name | Middle Name |
| Sebille Street Address 1 |
Fabien Street Address 2 |
|
| 4 Oppenheimer Street | Science Park | |
| City Rehovot |
State/Province/Country ISRAEL |
ZIP/PostalCode 7670104 |
| Relationship: X Executive Officer |
Director Promoter |
|
| Clarification of Response (if Necessary): | ||
| Chief Business Officer | ||
| 4. Industry Group | ||
| Agriculture | Health Care | Retailing |
| Banking & Financial Services | X Biotechnology | Restaurants |
| Technology | ||
| Commercial Banking | Health Insurance | Computers |
| Insurance | Hospitals & Physicians | Telecommunications |
| Investing | Pharmaceuticals | Other Technology |
| Investment Banking | Other Health Care | |
| Pooled Investment Fund | Manufacturing | Travel |
| Is the issuer registered as an investment company under |
Real Estate | Airlines & Airports |
| the Investment Company | Commercial | Lodging & Conventions |
| Act of 1940? | Construction | Tourism & Travel Services |
| Yes No |
REITS & Finance | Other Travel |
| Other Banking & Financial Services | Residential | Other |
| Business Services | Other Real Estate | |
| Energy | ||
| Coal Mining | ||
| Electric Utilities | ||
| Energy Conservation | ||
| Environmental Services | ||
| Oil & Gas | ||
| Other Energy | ||
| 5. Issuer Size | ||
| Revenue Range | OR Aggregate Net Asset Value Range |
|
| X No Revenues | No Aggregate Net Asset Value | |
| \$1 - \$1,000,000 | \$1 - \$5,000,000 | |
| \$1,000,001 - \$5,000,000 | \$5,000,001 - \$25,000,000 | |
| \$5,000,001 - \$25,000,000 | \$25,000,001 - \$50,000,000 | |
| \$25,000,001 - \$100,000,000 |
\$50,000,001 - \$100,000,000 | |
| Over \$100,000,000 | Over \$100,000,000 |
| Decline to Disclose Decline to Disclose |
|
|---|---|
| Not Applicable Not Applicable |
|
| 6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply) | |
| Rule 504(b)(1) (not (i), (ii) or (iii)) X Rule 506(b) Rule 504 (b)(1)(i) Rule 506(c) Rule 504 (b)(1)(ii) Securities Act Section 4(a)(5) Rule 504 (b)(1)(iii) Investment Company Act Section 3(c) Section 3(c)(1) Section 3(c)(9) Section 3(c)(2) Section 3(c)(10) Section 3(c)(3) Section 3(c)(11) Section 3(c)(4) Section 3(c)(12) Section 3(c)(5) Section 3(c)(13) Section 3(c)(6) Section 3(c)(14) Section 3(c)(7) |
|
| 7. Type of Filing | |
| X New Notice Date of First Sale 2023-10-17 First Sale Yet to Occur Amendment |
|
| 8. Duration of Offering | |
| X No Does the Issuer intend this offering to last more than one year? Yes |
|
| 9. Type(s) of Securities Offered (select all that apply) | |
| Equity Pooled Investment Fund Interests Debt Tenant-in-Common Securities X Option, Warrant or Other Right to Acquire Another Security Mineral Property Securities X Security to be Acquired Upon Exercise of Option, Warrant or Other (describe) Other Right to Acquire Security 10. Business Combination Transaction |
|
| Is this offering being made in connection with a business combination transaction, such as a Yes X No merger, acquisition or exchange offer? Clarification of Response (if Necessary): |
|
| 11. Minimum Investment | |
| Minimum investment accepted from any outside investor \$ 0 USD | |
| 12. Sales Compensation | |
| Recipient Recipient CRD Number None H.C. Wainwright & Co., LLC 375 (Associated) Broker or Dealer X None (Associated) Broker or Dealer CRD Number X None |
|
| Street Address 1 Street Address 2 430 PARK AVENUE NEW YORK City State/Province/Country ZIP/Postal Code NEW YORK NEW YORK 10022 State(s) of Solicitation All States Non-US/Foreign |
|
| AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MT NE NV NH NJ NM X NY NC ND OH OK OR RI SC SD TN TX UT VT VA WA WV WI WY |
MO PA PR |
| 13. Offering and Sales Amounts | ||||
|---|---|---|---|---|
| Total Offering Amount | \$ 5,434,784 | USD | or | Indefinite |
| Total Amount Sold | \$ 5,434,784 | USD | ||
| Total Remaining to be Sold | \$ 0 | USD | or | Indefinite |
| Clarification of Response (if Necessary): | ||||
| This Form D is being filed in connection with the issuance of warrants to purchase up to 4,347,827 ADSs at an exercise price of \$1.25 per ADS, with each ADS representing 10 ordinary shares, no par value per share, of the Company. |
||||
| 14. Investors | ||||
| invested in the offering. invested in the offering: |
X Select if securities in the offering have been or may be sold to persons who do not qualify as accredited investors, and enter the number of such non-accredited investors who already have 0 Regardless of whether securities in the offering have been or may be sold to persons who do not qualify as accredited investors, enter the total number of investors who already have 1 |
|||
| 15. Sales Commissions & Finder's Fees Expenses | ||||
| expenditure is not known, provide an estimate and check the box next to the amount. | Provide separately the amounts of sales commissions and finders fees expenses, if any. If the amount of an | |||
| \$ 350,000 USD Sales Commissions |
Estimate | |||
| \$ 0 Finders' Fees |
USD Estimate |
|||
| Clarification of Response (if Necessary): | ||||
| \$1.4375 per ADS, each representing 10 ordinary shares, no par value per share, of the Company. | The placement agent also received a 1% management fee and warrants to purchase 304,348 ADSs at an exercise price of | |||
| 16. Use of Proceeds | ||||
| Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. If the amount is unknown, provide an estimate and check the box next to the amount. |
||||
| \$ 0 USD | Estimate | |||
| Clarification of Response (if Necessary): | ||||
| Signature and Submission | ||||
| Please verify the information you have entered and review the Terms of Submission below before signing | ||||
| and submitting this notice. Terms of Submission |
||||
| In submitting this notice, each identified issuer is: |
• Certifying that, if the issuer is claiming a Regulation D exemption for the offering, the issuer is not disqualified from relying on Rule 504 or Rule 506 for one of the reasons stated in Rule 504(b)(3) or Rule 506 (d).
Each Issuer identified above has read this notice, knows the contents to be true, and has duly caused this notice to be signed on its behalf by the undersigned duly authorized person.
For signature, type in the signer's name or other letters or characters adopted or authorized as the signer's signature.
| Issuer | Signature | Name of Signer |
Title | Date |
|---|---|---|---|---|
| PURPLE BIOTECH LTD. | /s/ Lior Fhima | Lior Fhima | Chief Financial Officer | 2023-10-31 |
* This undertaking does not affect any limits Section 102(a) of the National Securities Markets Improvement Act of 1996 ("NSMIA") [Pub. L. No. 104-290, 110 Stat. 3416 (Oct. 11, 1996)] imposes on the ability of States to require information. As a result, if the securities that are the subject of this Form D are "covered securities" for purposes of NSMIA, whether in all instances or due to the nature of the offering that is the subject of this Form D, States cannot routinely require offering materials under this undertaking or otherwise and can require offering materials only to the extent NSMIA permits them to do so under NSMIA's preservation of their anti-fraud authority.
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