Statement of Changes in Beneficial Ownership (4)
November 30 2022 - 12:35PM
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
|
OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response... 0.5 |
|
Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934 or Section 30(h) of the Investment
Company Act of 1940
|
|
1. Name
and Address of Reporting Person * Sachs Adam
David |
2. Issuer Name and Ticker or Trading
Symbol Vicarious Surgical Inc. [ RBOT ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
President and CEO |
(Last)
(First)
(Middle)
C/O VICARIOUS SURGICAL INC., 78 FOURTH AVENUE |
3. Date of Earliest Transaction (MM/DD/YYYY)
11/28/2022
|
(Street)
WALTHAM, MA 02451
(City)
(State)
(Zip)
|
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 |
Class A Common Stock |
11/28/2022 |
|
C |
|
11329 |
A |
(1) |
1254121 |
D |
|
Class A Common Stock |
11/28/2022 |
|
S(2) |
|
11329 |
D |
$3.43 (3) |
1242792 |
D |
|
Class A Common Stock |
11/28/2022 |
|
S(4) |
|
8325 |
D |
$3.45 (5) |
1234467 |
D |
|
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 |
Class B Common Stock |
(1) |
9/27/2022 |
|
C |
|
|
11329 |
(1) |
(1) |
Class A Common Stock |
11329 |
$0 |
11239063 |
D |
|
Explanation of
Responses: |
(1) |
Each share of Class B Common
Stock, par value $0.0001 per share (the "Class B Common Stock"),
was converted into one share of Class A Common Stock, par value
$0.0001 per share (the "Class A Common Stock"), for no additional
consideration at the option of the Reporting Person. The shares of
Class B Common Stock are convertible into an equal number of shares
of Class A Common Stock at the Reporting Person's election and have
no expiration date. |
(2) |
These shares were sold
pursuant to a Rule 10b5-1 trading plan adopted by the Reporting
Person on March 15, 2022. |
(3) |
This figure is the weighted
average sales price of multiple trades ranging from $3.37 to $3.48
per share. The Reporting Person undertakes to provide the staff of
the Securities Exchange Commission, Vicarious Surgical Inc. or any
security holder of Vicarious Surgical Inc. full information about
the number of shares sold at each separate price upon
request. |
(4) |
These shares were sold
pursuant to a Rule 10b5-1 trading plan adopted by the Reporting
Person on September 15, 2022. |
(5) |
This figure is the weighted
average sales price of multiple trades ranging from $3.36 to $3.62
per share. The Reporting Person undertakes to provide the staff of
the Securities Exchange Commission, Vicarious Surgical Inc. or any
security holder of Vicarious Surgical Inc. full information about
the number of shares sold at each separate price upon
request. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Sachs Adam David
C/O VICARIOUS SURGICAL INC.
78 FOURTH AVENUE
WALTHAM, MA 02451 |
X |
|
President and CEO |
|
Signatures
|
/s/ June Morris, Attorney-in-Fact |
|
11/30/2022 |
**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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