Initial Statement of Beneficial Ownership (3)
April 25 2016 - 12:06PM
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
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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
*
Annen Steven
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2. Date of Event Requiring Statement (MM/DD/YYYY)
4/21/2016
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3. Issuer Name
and
Ticker or Trading Symbol
Invuity, Inc. [IVTY]
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(Last)
(First)
(Middle)
C/O INVUITY, INC., 444 DE HARO STREET
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
___
X
___ Officer (give title below)
_____ Other (specify below)
See Remarks /
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(Street)
SAN FRANCISCO, CA 94107
(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
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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600
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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)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Employee Stock Option (right to buy)
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(1)
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11/16/2025
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Common Stock
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50000
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$13.00
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D
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Employee Stock Option (right to buy)
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(2)
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3/15/2026
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Common Stock
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10000
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$7.32
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D
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Explanation of Responses:
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(
1)
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One fifth of the shares subject to the option vest on November 2, 2016 and one sixtieth of the shares subject to the option vest each month thereafter, subject to the Reporting Person continuing as a service provider through each such date.
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(
2)
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Eight sixtieths of the shares subject to the option vest on November 15, 2016 and one sixtieth of the shares subject to the option vest each month thereafter, subject to the Reporting Person continuing as a service provider through each such date.
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Remarks:
VP of Product Management and Strategy
Exhibit 24 - Power of Attorney
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Annen Steven
C/O INVUITY, INC.
444 DE HARO STREET
SAN FRANCISCO, CA 94107
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See Remarks
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Signatures
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/s/ Nancy Hargreaves, by power of attorney
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4/25/2016
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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