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*
Werth Peter J.

(Last) (First) (Middle)
C/O CINGULATE INC.
1901 W. 47TH PLACE

(Street)
KANSAS CITY KS 66205

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Cingulate Inc. [ CING ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
04/11/2024
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Rule 10b5-1(c) Transaction Indication

  
Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.
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
Common Stock 04/11/2024 M 341,912 A $0.002 481,829 I By Werth Family Investment Associates LLC(1)
Common Stock 04/11/2024 M 694,096 A $0.0001 1,175,925 I By Werth Family Investment Associates LLC(1)
Common Stock 1,093 D
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
Pre-Funded Warrant (right to buy) $0.002(2) 04/11/2024 M 341,912(2) 09/08/2023 (3) Common Stock 341,912(2) $0 0 I By Werth Family Investment Associates LLC(1)
Pre-Funded Warrant (right to buy) $0.0001 04/11/2024 M 694,096 (4) (3) Common Stock 694,096 $0 0 I By Werth Family Investment Associates LLC(1)
1. Name and Address of Reporting Person*
Werth Peter J.

(Last) (First) (Middle)
C/O CINGULATE INC.
1901 W. 47TH PLACE

(Street)
KANSAS CITY KS 66205

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Werth Family Investment Associates LLC

(Last) (First) (Middle)
C/O CINGULATE INC.
1901 W. 47TH PLACE

(Street)
KANSAS CITY KS 66205

(City) (State) (Zip)
Explanation of Responses:
1. Reporting person disclaims beneficial ownership of these securities except to the extent of their pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose.
2. The number of pre-funded warrants and shares and the exercise price reflect the 1-for-20 reverse stock split of the Issuer's issued and outstanding shares of common stock, which became effective on November 30, 2023.
3. The pre-funded warrants have no expiration date.
4. 687,043 of the pre-funded warrants were issued and immediately exercisable on January 25, 2024, and 7,053 of the pre-funded warrants were issued and immediately exercisable on March 25, 2024.
/s/ Shane J. Schaffer, Attorney-in-Fact Peter J. Werth 04/12/2024
/s/ Shane J. Schaffer, Attorney-in-Fact Peter J. Werth, for Werth Family Investment Associates LLC 04/12/2024
** 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 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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