Statement of Changes in Beneficial Ownership (4)
January 06 2021 - 5:00PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
Ianchulev Tsontcho |
2. Issuer Name and Ticker or Trading Symbol
EYENOVIA, INC.
[
EYEN
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Chief Executive Officer |
(Last)
(First)
(Middle)
C/O EYENOVIA, INC., 295 MADISON AVENUE, SUITE 2400 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
1/5/2021 |
(Street)
NEW YORK, NY 10017
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock, par value $.0001 | 1/5/2021 | | X | | 41216 | A | $2.27 | 549895 | D | |
Common Stock, par value $.0001 | | | | | | | | 606667 | I | By Private Medical Equity, Inc. (1) |
Common Stock, par value $.0001 | | | | | | | | 6000 | I | By The Meliora Trust (1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 7. Title and Amount of Securities Underlying Derivative Security (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) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Class A Warrant | $2.27 (2) | 1/5/2021 | | X | | | 41216 | 3/24/2020 | 3/24/2021 | Common Stock | 41216 (3) | $0.000 | 0 (3) | D | |
Class B Warrant | $2.724 (2) | | | | | | | 3/24/2020 | 3/24/2025 | Common Stock | 61823 (3) | | 61823 (3) | D | |
Stock Option (right to buy) | $1.95 | | | | | | | (4) | 7/7/2027 | Common Stock | 267370 | | 267370 | D | |
Stock Option (right to buy) | $6.20 | | | | | | | (5) | 7/24/2028 | Common Stock | 124210 | | 124210 | D | |
Stock Option (right to buy) | $3.11 | | | | | | | (6) | 8/16/2029 | Common Stock | 183703 | | 183703 | D | |
Stock Option (right to buy) | $2.72 | | | | | | | (7) | 6/2/2030 | Common Stock | 285255 | | 285255 | D | |
Stock Option (right to buy) | $1.24 | | | | | | | 3/23/2015 | 3/23/2025 | Common Stock | 140000 | | 140000 | I | By Private Medical Equity, Inc. (1) |
Explanation of Responses: |
(1) | The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose. |
(2) | The exercise price per share of the Issuer's common stock issuable upon exercise of the Class A and Class B Warrants is subject to adjustment for stock splits, stock dividends and similar corporate events. |
(3) | The number of shares of Issuer common stock issuable upon exercise of the Class A and Class B Warrants is subject to adjustment for stock splits, stock dividends and similar corporate events. |
(4) | The option became exercisable as to 11,140 shares on August 7, 2017 and became exercisable in equal 11,140 share amounts on each of the 35 one-month anniversaries thereafter. |
(5) | This option is fully vested. |
(6) | One-third of the option became exercisable on August 16, 2020 and the remaining shares underlying the option become exercisable in equal increments on each of the 24 one-month anniversaries thereafter. |
(7) | One-third of this option becomes exercisable on June 3, 2021 and the remaining shares underlying the option become exercisable in equal increments on each of the 24 one-month anniversaries thereafter. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Ianchulev Tsontcho C/O EYENOVIA, INC. 295 MADISON AVENUE, SUITE 2400 NEW YORK, NY 10017 | X |
| Chief Executive Officer |
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Signatures
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/s/ S. Halle Vakani, Attorney-in-Fact | | 1/6/2021 |
**Signature of Reporting Person | Date |
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