Statement of Changes in Beneficial Ownership (4)
June 22 2021 - 6:01PM
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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3235-0287
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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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Gurrola Sandra M |
2. Issuer Name and Ticker or Trading Symbol
Brooklyn ImmunoTherapeutics, Inc.
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BTX
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Vice President of Finance |
(Last)
(First)
(Middle)
C/O BROOKLYN IMMUNOTHERAPEUTICS, INC., 140 58TH STREET, BUILDING A, SUITE 2100 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/21/2021 |
(Street)
BROOKLYN, NY 11220
(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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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 |
Restricted Stock Unit | (1) | 6/21/2021 | | A | | 35000 | | (2) | (2) | Common Stock | 35000 | $0 | 35000 | D | |
Explanation of Responses: |
(1) | Each restricted stock unit represents a contingent right to receive one share of common stock. |
(2) | The option vests and becomes exercisable in four equal installments on June 21 of each of 2022, 2023, 2024 and 2025, provided they shall vest in full immediately prior to a Change in Control (as defined in Ms. Gurrola's Executive Employment Agreement, dated as of June 16, 2021 and effective as of June 21, 2021), subject to continued service through each vesting date. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Gurrola Sandra M C/O BROOKLYN IMMUNOTHERAPEUTICS, INC. 140 58TH STREET, BUILDING A, SUITE 2100 BROOKLYN, NY 11220 |
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| Vice President of Finance |
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Signatures
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/s/ Mark L. Johnson, Attorney-in-Fact for Sandra M. Gurrola | | 6/22/2021 |
**Signature of Reporting Person | Date |
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