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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) |
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 | ||||||||
Common Stock Option | $ 3.15 | 08/30/2022 | J(3) | 60,373 (4) | 08/30/2022 | 11/13/2028 | Common Stock | 60,373 | $ 0 | 60,373 (4) | D | ||||
Warrant | $ 3.15 | 08/30/2022 | J(5) | 31,774 | 08/30/2022 | 11/26/2023 | Common Stock | 31,774 | $ 0 | 31,774 | D | ||||
Warrant | $ 3.15 | 08/30/2022 | J(5) | 4,585 | 08/30/2022 | 12/14/2023 | Common Stock | 4,585 | $ 0 | 4,585 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Mendelsohn Adam C/O 5858 HORTON ST, SUITE 280 EMERYVILLE, CA 94608 |
X | CEO |
/s/ Adam Mendelsohn | 08/31/2022 | |
**Signature of Reporting Person | Date |
* | 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) | Represents shares of common stock issued in the acquisition transaction of Nano Precision Medical Inc. consummated August 30, 2022. |
(2) | Represents shares of common stock held by three trusts for the benefit of the children of the Reporting Person, over which the Reporting Person and his spouse have joint voting and diapositive authority. The Reporting Person disclaims pecuniary ownership in the shares of common stock held by the three trusts. Excludes 77,331 shares of common stock held by MFE, LLC in which the Reporting Person has a 10% ownership interest and therefore a pecuniary interest in such shares, but over which the Reporting Person does not have any voting or diapositive authority. |
(3) | Represents the replacement option to be issued by Vivani Medical, Inc. (f/k/a Second Sight Medical Products, Inc.) at the effective time of the merger acquisition thereof, pursuant to the terms of the Agreement and Plan of Merger entered into on February 4, 2022. |
(4) | The option vests 1/48 per month over the four years after the date of grant commencing on December 12, 2018, and the balance thereafter vests in full on the fifth anniversary of the date of grant. |
(5) | Represents warrants to purchase shares of common stock assumed on the effective date of the acquisition of Nano Precision Medical, Inc., consummated on August 30, 2022 pursuant to the Agreement and Plan of Merger dated February 4, 2022. |