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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 | ||||||||
Series A-2 Preferred Stock | (4) | 06/12/2017 | C | 380 | (4) | (4) | Common Stock | 271 | (5) | 0 | D | ||||
Series B-1 Preferred Stock | (6) | 06/12/2017 | C | 458 | (6) | (6) | Common Stock | 458 | (5) | 0 | D | ||||
Warrant (Right to Buy) | (7) | 06/12/2017 | C | 48 | (8) | 08/31/2019 | Common Stock | 48 | (5) | 48 | D | ||||
Series A-2 Preferred Stock | (4) | 06/12/2017 | C | 16,343 | (4) | (4) | Common Stock | 11,694 | (5) | 0 | I | By Trust (1) | |||
Series B-1 Preferred Stock | (6) | 06/12/2017 | C | 13,764 | (6) | (6) | Common Stock | 13,764 | (5) | 0 | I | By Trust (1) | |||
Warrant (Right to Buy) | (7) | 06/12/2017 | C | 1,800 | (8) | 08/31/2019 | Common Stock | 1,800 | (5) | 1,800 | I | By Trust (1) | |||
Series A-2 Preferred Stock | (4) | 06/12/2017 | C | 1,570 | (4) | (4) | Common Stock | 1,123 | (5) | 0 | I | By Trust (2) | |||
Series B-1 Preferred Stock | (6) | 06/12/2017 | C | 10,110 | (6) | (6) | Common Stock | 10,110 | (5) | 0 | I | By Trust (2) | |||
Warrant (Right to Buy) | (7) | 06/12/2017 | C | 785 | (8) | 08/31/2019 | Common Stock | 785 | (5) | 785 | I | By Trust (2) | |||
Series A-2 Preferred Stock | (4) | 06/12/2017 | C | 2,237 | (4) | (4) | Common Stock | 1,600 | (5) | 0 | I | By Limited Liability Company (3) | |||
Series B-1 Preferred Stock | (6) | 06/12/2017 | C | 2,473 | (6) | (6) | Common Stock | 2,473 | (5) | 0 | I | By Limited Liability Company (3) | |||
Warrant (Right to Buy) | (7) | 06/12/2017 | C | 262 | (8) | 07/12/2019 | Common Stock | 262 | (5) | 262 | I | By Limited Liability Company (3) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Levensohn Pascal 1971 VALLEJO STREET SAINT HELENA, CA 94574 |
X |
/s/ Pascal Levensohn | 06/12/2017 | |
**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) | Shares are held directly by Pascal Levensohn Revocable Trust, over which Reporting Person holds voting and dispositive power. |
(2) | Shares are held directly by Levensohn 2000 Children's Trust, over which Reporting Person holds voting and dispositive power. |
(3) | Shares are held directly by Levensohn Securities Holdings, LLC, over which Reporting Person holds voting and dispositive power. |
(4) | Each share of Series A-2 Preferred Stock automatically converted into 0.715548 shares of Common Stock upon the closing of the Issuer's initial public offering of Common Stock and has no expiration date. |
(5) | Inapplicable. |
(6) | Each share of Series B-1 Preferred Stock automatically converted into 1 share of Common Stock upon the closing of the Issuer's initial public offering of Common Stock and has no expiration date. |
(7) | Right has converted from right to buy Series B-1 Preferred Stock to right to buy Common Stock. |
(8) | Immediate. |