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*
DOW GEOFFREY S

(Last) (First) (Middle)
C/O 60 DEGREES PHARMACEUTICALS, INC.
1025 CONNECTICUT AVENUE NW SUITE 1000

(Street)
WASHINGTON DC 20036

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/11/2023
3. Issuer Name and Ticker or Trading Symbol
60 DEGREES PHARMACEUTICALS, INC. [ SXTP ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
CEO and President
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 667,143 I By Trust(1)
Common Stock 10,482(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
Warrants (right to buy) 05/19/2022 05/19/2027 Common Stock 10,482 4.77 D
Explanation of Responses:
1. 667,143 shares of common stock held by the Geoffrey S. Dow Revocable Trust, of which Geoffrey Dow is the trustee and has voting and dispositive control.
2. Shares issued pursuant to the automatic conversion of that certain 10% OID Promissory Note, dated May 19, 2022, bearing interest at the rate of 6% per annum, in the principal amount of $44,444 at a conversion price of $4.24 per share (80% of the Company's initial public offering price).
/s/ Geoffrey Dow 07/11/2023
** 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).
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