SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Harsaul Foundation

(Last) (First) (Middle)
EDIFICIO AFRA
AVENIDA SAMUEL LEWIS Y CALLE 54

(Street)
PANAMA R1 0

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Osmotica Pharmaceuticals plc [ OSMT ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
01/13/2020
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Ordinary Shares 01/13/2020 P 1,250,000 A $5(1) 22,485,297 I By Self as indirect owner of Altchem Limited(2)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. The acquisition of Ordinary Shares reported on this Form 4 (the "Acquired Shares") was made pursuant to an underwritten public offering of Ordinary Shares by Osmotica Pharmaceuticals plc (the "Issuer"). In connection with such offering, the underwriters reimbursed the Issuer for any discounts and commissions payable by the Issuer with respect to the Acquired Shares (the "Discount"). The Issuer in turn paid a fee equal to the amount of the Discount to Altchem Limited totaling $406,250 (the "Fee"), or $0.325 per share. The $5.00 per share price does not reflect payment of the Fee to Altchem Limited.
2. Represents shares of the Issuer held by Altchem Limited. Harsaul Foundation is the indirect owner of Altchem Limited. As a result, Harsaul Foundation may be deemed to share voting and investment power with respect to the shares held by Altchem Limited.
Harsaul Foundation, by Dirserv Inc., Foundation Council Member By: /s/ Camilo A. Mendez Chong 01/15/2020
** 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 4 (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).
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