SC 13G/A 1 mict20210211_sc13ga.htm SCHEDULE 13G/A kmph20180207_sc13ga.htm

 

SECURITIES AND EXCHANGE COMMISSION

WASHINGTON, DC 20549

 


 

SCHEDULE 13G

 

UNDER THE SECURITIES EXCHANGE ACT OF 1934

(Amendment No. 5)*

 


 

KemPharm, Inc.

(Name of Issuer)

 

Common Stock, $0.0001 par value per share

(Title of Class of Securities)

 

488445206

(CUSIP Number)

 

December 31, 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)

 

☐     Rule 13d-1(c)

 

☒     Rule 13d-1(d)

 

*

The remainder of this cover page shall be filled out for a reporting persons 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 be subject to all other provisions of the Act (however, see the Notes).

 



 

 

 

 

1.

 

Names of Reporting Persons

 

Travis C. Mickle

2.

 

Check the Appropriate Box if a Member of a Group (see instructions)

(a) (b)

 

3.

 

SEC USE ONLY

 

4.

 

Citizenship or Place of Organization

 

United States

Number of

Shares

Beneficially

Owned by

Each

Reporting

Person

With:

5.

Sole Voting Power

 

201,358 shares (1)

6.

Shared Voting Power

 

26,187 shares (2)

7.

Sole Dispositive Power

 

201,358 shares (1)

8.

Shared Dispositive Power

 

26,187 shares (2)

9.

 

Aggregate Amount Beneficially Owned by Each Reporting Person

 

227,545 shares (1)(2)

10.

 

Check if the Aggregate Amount in Row (9) Excludes Certain Shares (see instructions)

11.

 

Percent of Class Represented by Amount in Row 9

 

4.9% (3)

12.

 

Type of Reporting Person (see instructions)

 

IN

 

1.

Consists of 118,007 shares of common stock held directly by Travis C. Mickle (“Dr. Mickle”), 15,242 shares of common stock held by the Christal M.M. Mickle 2015 Gift Trust u/d/p July 21, 2015, for which Dr. Mickle serves as trustee, and 68,109 shares of common stock which Dr. Mickle has the right to acquire within sixty days of December 31, 2020 upon exercise of outstanding stock options.

2.

Consists of 6,287 shares of common stock held jointly with Christal M.M. Mickle (“Ms. Mickle”), 9,824 shares of common stock held by the Travis C. Mickle 2015 Dynasty Trust u/d/p July 21, 2015, for which Ms. Mickle serves as trustee, 7,701 shares of common stock held by the Mickle Family Trust u/d/p April 30, 2009, for which Dr. Mickle and Ms. Mickle serve as co-trustees, 1,341 shares of common stock held by the TCM Family Trust u/d/p April 30, 2009, for which Dr. Mickle and Ms. Mickle serve as co-trustees, and 1,034 shares of common stock held by Mickle Investments LLC, for which Dr. Mickle and Ms. Mickle serve as managing members. 

3.

This percentage is calculated based upon 4,537,321 shares of the Issuer’s common stock outstanding as of December 31, 2020 as provided by KemPharm, Inc.

 

 

 

 

Item 1(a)

Name of Issuer

 

KemPharm, Inc.

 

Item 1(b)

Address of Issuer’s Principal Executive Offices

 

1180 Celebration Boulevard, Suite 103 

Celebration, FL 34747

 

Item 2(a)

Name of Person Filing

 

Travis C. Mickle (Dr. Mickle”)

 

Item 2(b)

Address of Principal Business Office or, if none, Residence

 

c/o KemPharm, Inc.

1180 Celebration Boulevard, Suite 103 

Celebration, FL 34747

 

Item 2(c)

Citizenship

 

United States

 

Item 2(d)

Title of Class of Securities

 

Common Stock, $0.0001 par value

 

Item 2(e)

CUSIP Number

 

488445206

 

Item 3

 

 

Not applicable.

 

 

 

 

Item 4

Ownership

 

Holder (1)

 

Shares Held
Directly

 

Sole Voting
Power

 

Shared
Voting
Power

 

Sole
Dispositive
Power

 

Shared
Dispositive
Power

 

Beneficial
Ownership

 

Percentage of
Class (1)

               

Travis C. Mickle

 

201,358

(2)

 

201,358

(2)

 

26,187

(3)

 

201,358

(2)

 

26,187

(3)

 

227,545

(2)(3)

 

4.9%

 

(1)

This percentage is calculated based upon 4,537,321 shares of the Issuer’s common stock outstanding as of December 31, 2020 as disclosed by KemPharm, Inc.

(2)

Consists of 118,007 shares of common stock held directly by Travis C. Mickle (Dr. Mickle”), 15,242 shares of common stock held by the Christal M.M. Mickle 2015 Gift Trust u/d/p July 21, 2015, for which Dr. Mickle serves as trustee, and 68,109 shares of common stock which Dr. Mickle has the right to acquire within sixty days of December 31, 2020 upon exercise of outstanding stock options.

(3)

Consists of 6,287 shares of common stock held jointly by Dr. Mickle and Christal M.M. Mickle (“Ms. Mickle”), 9,824 shares of common stock held by the Travis C. Mickle 2015 Dynasty Trust u/d/p July 21, 2015, for which Ms. Mickle serves as trustee, 7,701 shares of common stock held by the Mickle Family Trust u/d/p April 30, 2009, for which Dr. Mickle and Ms. Mickle serve as co-trustees, 1,341 shares of common stock held by the TCM Family Trust u/d/p April 30, 2009, for which Dr. Mickle and Ms. Mickle serve as co-trustees, and 1,034 shares of common stock held by Mickle Investments LLC, for which Dr. Mickle and Ms. Mickle serve as managing members.

 

Item 5

Ownership of Five Percent or Less of a Class

 

If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following. ☒ 

 

Item 6

Ownership of More than Five Percent 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

Certification

 

Not applicable.

 

 

 

 

SIGNATURES

 

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.

 

EXECUTED this 11th day of February, 2021.

 

/s/ Travis C. Mickle

Travis C. Mickle, Ph.D.