4: Statement of changes in beneficial ownership of securities
Published on July 2, 2021
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
(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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Options to Purchase Common Stock | $ 3.03 | 06/30/2021 | A | 100,000 | 06/30/2021 | 06/30/2026 | Common | 100,000 | $ 0 (1) | 100,000 | D | ||||
Options to Purchase Common Stock | $ 3.21 | 01/06/2021 | 01/06/2026 | Common | 50,000 | 50,000 | D | ||||||||
Warrants to Purchase Common Stock | $ 5.7 | 12/07/2018 | 12/07/2022 | Common | 21,053 | 21,053 | I | By Stephen Forman Living Trust | |||||||
Options to Purchase Common Stock | $ 0.96 | 05/13/2016 | 05/13/2021 | Common | 33,333 | 33,333 | D | ||||||||
Options to Purchase Common Stock | $ 0.9 | 10/16/2017 | 10/16/2022 | Common | 8,333 | 8,333 | D | ||||||||
Options to Purchase Common Stock | $ 6.6 | 05/22/2019 | 05/22/2024 | Common | 8,333 | 8,333 | D | ||||||||
Warrants to Purchase Common Stock | $ 6 | 12/07/2018 | 12/07/2022 | Common | 16,667 | 16,667 | I | By Stephen Forman Living Trust |
Reporting Owners
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Forman Stephen J. 161 W ALTADENA DR. PHB 3447 ALTADENA, CA 91001 |
X |
Signatures
/s/ Stephen Forman | 07/01/2021 | |
**Signature of Reporting Person | Date |
Explanation of Responses:
* | 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). |
(1) | Effective June 30, 2021, the reporting person was granted stock options to purchase an aggregate of 100,000 shares, vesting in eight equal installments on the last day of each subsequent quarter until fully vested (e.g. vesting to start on September 20, 2021). |