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*
MERTZ LEONARD POWELL

(Last) (First) (Middle)
C/O ALPHA COGNITION INC.
1200 - 750 WEST PENDER STREET

(Street)
VANCOUVER A1 V6C 2T8

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/12/2024
3. Issuer Name and Ticker or Trading Symbol
Alpha Cognition Inc. [ ACOG ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
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 Shares 138,495 D
Common Shares 85,030 I by The Len Mertz Trust
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
Common Share Options 01/18/2023(1) 12/20/2031 Common Shares 12,000 $5.21(2) D
Common Share Options 01/18/2023(1) 05/31/2032 Common Shares 4,000 $5.21(2) D
Common Share Options 06/08/2023(3) 06/08/2033 Common Shares 20,000 $4.12(4) D
Class B Preferred Series A Shares (5) (5) Common Shares 60,015 $0(5) D
Explanation of Responses:
1. Options are fully vested.
2. Converted from Canadian exercise price of C$7.00 at C$1.3439=USD$1.00.
3. 12.5% vested on June 8, 2023, and the remaining 87.5% vests in equal monthly installments until January 30, 2026.
4. Converted from Canadian exercise price of C$5.50 at C$1.3358=USD$1.00.
5. The Class B Preferred Series A Shares are convertible at any time, at the holder's election, on a one-for-one basis, and will convert automatically upon certain events as described in the Issuer's Form S-1 registration statement. The Class B Preferred Series A Shares do not expire.
/s/ Mertz Leonard Powell 11/12/2024
** 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 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).
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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