Statement of Changes in Beneficial Ownership (4)
June 08 2023 - 07:18PM
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).
|
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 * Shany Gilad |
2. Issuer Name and Ticker or Trading
Symbol Innovid Corp. [ CTV ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
_____ Officer (give title
below) _____ Other
(specify below)
|
(Last)
(First)
(Middle)
C/O INNOVID CORP, 30 IRVING PLACE, 12TH FLOOR |
3. Date of Earliest Transaction (MM/DD/YYYY)
6/7/2023
|
(Street)
NEW YORK, NY 10003 |
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 |
(City)
(State)
(Zip)
|
Rule 10b5-1(c) Transaction Indication
☐ Check this box to indicate
that a transaction was made pursuant to a contract, instruction or
written plan that is intended to satisfy the affirmative defense
conditions of Rule 10b5-1(c). See Instruction 10. |
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 |
Common Stock |
6/7/2023 |
|
A |
|
147059 (1) |
A |
$0.00 |
1220662 (2) |
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 |
Warrants to purchase Common
Stock |
$11.50 |
|
|
|
|
|
|
(3) |
11/30/2026 |
Common Stock |
996283 |
|
996283 (4) |
D |
|
Explanation of
Responses: |
(1) |
Represents restricted stock
units, 100% of which will vest on the earlier of (i) June 7, 2024,
or (ii) the date of the next annual meeting of stockholders of the
Issuer, subject to the Reporting Person's continued service to the
Issuer. Each restricted stock unit represents a contingent right to
receive one share of the Issuer's common stock. |
(2) |
Includes 881,979 shares of
Common Stock acquired in a pro-rata distribution in-kind, the
acquisition of which was exempt from reporting pursuant to Rule
16a-9. |
(3) |
The Warrants are currently
exercisable. |
(4) |
Reflects warrants acquired
in a pro-rata distribution in-kind, the acquisition of which was
exempt from reporting pursuant to Rule 16a-9. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Shany Gilad
C/O INNOVID CORP
30 IRVING PLACE, 12TH FLOOR
NEW YORK, NY 10003 |
X |
|
|
|
Signatures
|
By: Nick Williams, Attorney-in-fact For: Gilad
Shany |
|
6/8/2023 |
**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. |
Innovid (NYSE:CTV)
Historical Stock Chart
From Aug 2023 to Sep 2023
Innovid (NYSE:CTV)
Historical Stock Chart
From Sep 2022 to Sep 2023