SEC 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
|Estimated average burden|
|hours per response:
1. Name and Address of Reporting Person*
|2525 WEST END AVENUE|
2. Date of Event Requiring Statement
3. Issuer Name and Ticker or Trading Symbol
CUMBERLAND PHARMACEUTICALS INC
[ CPIX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
5. If Amendment, Date of Original Filed
6. Individual or Joint/Group Filing (Check Applicable Line)
||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.
Amount of Securities Beneficially Owned (Instr.
||3. Ownership Form: Direct (D) or Indirect (I) (Instr.
||4. Nature of Indirect Beneficial Ownership (Instr.
Table II - Derivative Securities Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Date Exercisable and Expiration Date
||3. Title and Amount of Securities Underlying Derivative Security (Instr.
||4. Conversion or Exercise Price of Derivative Security
||5. Ownership Form: Direct (D) or Indirect (I) (Instr.
||6. Nature of Indirect Beneficial Ownership (Instr.
||Amount or Number of Shares
|Explanation of Responses:|
||Kenneth J. Krogulski by: /s/ Michael Bonner as attorney-in-fact
||** Signature of Reporting Person
|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,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
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,
Instruction 6 for procedure.|
|Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.|
POWER OF ATTORNEY
Know all by these presents, I hereby appoint Michael Bonner and Jean W.
Marstiller, or any one of them, to act as my agent and attorney-in-fact for the
purpose of completing, executing and filing on my behalf with the Securities and
Exchange Commission, the NASDAQ Stock Market LLC or any other exchange or
self-regulatory body, any Form 3 "Initial Statement of Beneficial Ownership of
Securities", Form 4 "Statement of Changes in Beneficial Ownership of
Securities", Form 5 "Annual Statement of Beneficial Ownership of Securities",
Form 144 "Notice of Proposed Sale of Securities", Schedule 13D pursuant to Rule
13d-101 of the Securities Exchange Act of 1934, or any other similar form to
report securities ownership that may, in the opinion of any of them be
necessary, with respect to any transaction in securities of Cumberland
Nothing herein shall relieve me of the responsibility for the accuracy of the
information and representations contained in any Form 3, Form 4, Form 5, Form
144, Schedule 13D, or other similar form completed, executed and filed pursuant
to this power of attorney.
This power of attorney shall supersede all similar prior powers of attorney and
will remain effective
as to the agents and attorneys-in-fact referred to above
until I revoke or amend it by written notice to such persons or until the
undersigned is no longer required to file Form 3, Form 4, Form 5, Form 144,
Schedule 13D or other similar form completed, executed and filed pursuant to
this power of attorney.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed on this 18th day of January 2017.
/s/ Kenneth J. Krogulski
Kenneth J. Krogulski