Statement of Changes in Beneficial Ownership (4)
November 22 2022 - 05:15PM
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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
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OMB
APPROVAL
OMB Number: 3235-0287
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 * Kong Garheng |
2. Issuer Name and Ticker or Trading
Symbol Venus Concept Inc. [ VERO ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director __X__
10% Owner
_____ Officer (give title
below) _____ Other
(specify below)
|
(Last)
(First)
(Middle)
C/O VENUS CONCEPT INC., 235 YORKLAND BLVD., SUITE
900 |
3. Date of Earliest Transaction (MM/DD/YYYY)
11/18/2022
|
(Street)
TORONTO, A6 M2J 4Y8
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
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 Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
Amount |
(A) or (D) |
Price |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
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 |
Voting Convertible Preferred
Stock |
$0 (1) |
11/18/2022 |
|
P |
|
335000 |
|
11/18/2022 |
(1) |
Common Stock |
3350000 |
$2.00 |
335000 |
I |
HealthQuest Partners II, L.P. (2) |
Explanation of
Responses: |
(1) |
The Voting Preferred Stock
will convert into shares of Common Stock on a one for ten basis (i)
at the option the holder or (ii) at the option of the Company
within 30 days following the occurrence of certain events. The
Voting Preferred Stock votes with the Common Stock on an
as-converted basis. The Voting Preferred Stock does not
expire. |
(2) |
The shares were purchased by
HealthQuest Partners II, L.P. ("HealthQuest"). HealthQuest Venture
Management II, L.L.C. ("HQVM II"), the general partner of
HealthQuest, and Garheng Kong, the managing member of HQVM II, may
be deemed to have sole voting and dispositive power with respect to
the shares held of record by HealthQuest. The Reporting Person and
HQVM II disclaim beneficial ownership of all shares held by
HealthQuest except to the extent of any pecuniary interest
therein. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Kong Garheng
C/O VENUS CONCEPT INC.
235 YORKLAND BLVD., SUITE 900
TORONTO, A6 M2J 4Y8 |
X |
X |
|
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Signatures
|
/s/ Michael Mandarello as attorney-in-fact for
Garheng Kong |
|
11/22/2022 |
**Signature of Reporting
Person |
Date |
Reminder: Report on a separate line for each class
of securities beneficially owned directly or
indirectly. |
* |
If the form is filed by more than one
reporting person, see Instruction 4(b)(v). |
** |
Intentional misstatements or omissions
of facts constitute Federal Criminal Violations. See 18
U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: |
File three copies of this Form, one of
which must be manually signed. If space is insufficient, see
Instruction 6 for procedure. |
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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