Initial Statement of Beneficial Ownership (3)
May 29 2020 - 07:13PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE
COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP
OF SECURITIES
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OMB
APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response... 0.5 |
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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 * Park Andrea Eun
Jae |
2. Date of Event Requiring Statement
(MM/DD/YYYY)
5/15/2020
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3. Issuer Name and Ticker or Trading
Symbol AgeX Therapeutics, Inc. [AGE] |
(Last)
(First)
(Middle)
C/O AGEX THERAPEUTICS, INC., 965 ATLANTIC AVENUE, SUITE
101 |
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
___X___ Officer (give title
below) _____
Other (specify below)
Chief Financial Officer / |
(Street)
ALAMEDA, CA 94501
(City)
(State)
(Zip)
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5. 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 |
Table I - Non-Derivative Securities Beneficially
Owned
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1.Title of Security
(Instr. 4) |
2. Amount of Securities Beneficially Owned
(Instr. 4) |
3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5) |
4. Nature of Indirect Beneficial Ownership
(Instr. 5) |
Common Stock, $0.0001 par value |
351 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
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1. Title of Derivate Security
(Instr. 4) |
2. Date Exercisable and Expiration Date
(MM/DD/YYYY) |
3. Title and Amount of Securities Underlying
Derivative Security
(Instr. 4) |
4. Conversion or Exercise Price of Derivative
Security |
5. Ownership Form of Derivative Security: Direct (D)
or Indirect (I)
(Instr. 5) |
6. Nature of Indirect Beneficial Ownership
(Instr. 5) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Option to Purchase Common Stock |
(1) |
9/30/2029 |
Common Stock |
20000 |
$1.77 |
D |
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Option to Purchase Common Stock |
(2) |
5/14/2030 |
Common Stock |
300000 |
$0.738 |
D |
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Explanation of
Responses: |
(1) |
One quarter shall vest on
October 1, 2020 and the remaining shall vest monthly over 36
months, based upon continuous service. |
(2) |
One quarter shall vest on
May 15, 2021 and the remaining shall vest monthly over 36 months,
based upon continuous service. |
Reporting
Owners
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Reporting Owner Name / Address |
Relationships
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Director |
10% Owner |
Officer |
Other |
Park Andrea Eun Jae
C/O AGEX THERAPEUTICS, INC.
965 ATLANTIC AVENUE, SUITE 101
ALAMEDA, CA 94501 |
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Chief Financial Officer |
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Signatures
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/s/Andrea E. Park |
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5/29/2020 |
**Signature of Reporting
Person |
Date |