Statement of Changes in Beneficial Ownership (4)
January 19 2021 - 4:41PM
Edgar (US Regulatory)
FORM 4
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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
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MARIO ERNEST |
2. Issuer Name and Ticker or Trading Symbol
EYENOVIA, INC.
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EYEN
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O EYENOVIA, INC., 295 MADISON AVENUE, SUITE 2400 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
1/15/2021 |
(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 | 1/15/2021 | | X | | 41216 | A | $2.27 | 375743 | D | |
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 (1) | 1/15/2021 | | X | | | 41216 | 3/24/2020 | 3/24/2021 | Common Stock | 41216 (2) | $0.00 | 0 (2) | D | |
Class B Warrant | $2.724 (1) | | | | | | | 3/24/2020 | 3/24/2025 | Common Stock | 61823 (2) | | 61823 (2) | D | |
Stock Option (right to buy) | $1.24 | | | | | | | 3/23/2015 | 3/23/2025 | Common Stock | 40000 | | 40000 | D | |
Stock Option (right to buy) | $1.95 | | | | | | | (3) | 7/7/2027 | Common Stock | 33334 | | 33334 | D | |
Stock Option (right to buy) | $6.20 | | | | | | | (3) | 7/24/2028 | Common Stock | 4465 | | 4465 | D | |
Stock Option (right to buy) | $3.11 | | | | | | | (3) | 8/16/2029 | Common Stock | 9057 | | 9057 | D | |
Stock Option (right to buy) | $3.43 | | | | | | | (4) | 9/11/2030 | Common Stock | 9820 | | 9820 | D | |
Explanation of Responses: |
(1) | 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. |
(2) | 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. |
(3) | The option is fully vested. |
(4) | The option becomes exercisable on the earlier of September 11, 2021 or the date of the Issuer's 2021 annual meeting of stockholders, subject to the Reporting Person's continued service on the Issuer's Board of Directors and acceleration upon change in control. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
MARIO ERNEST C/O EYENOVIA, INC. 295 MADISON AVENUE, SUITE 2400 NEW YORK, NY 10017 | X |
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Signatures
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/s/ S. Halle Vakani, Attorney-in-Fact | | 1/19/2021 |
**Signature of Reporting Person | Date |
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