1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Option to purchase Common Stock, par value $0.0001
|
08/24/2021 |
08/24/2026 |
Common Stock
|
300,000
|
$
5.35
|
D
|
|
Option to purchase Common Stock, par value $0.0001
|
08/24/2022 |
08/24/2027 |
Common Stock
|
150,000
(2)
|
$
5.35
|
D
|
|
Option to purchase Common Stock, par value $0.0001
|
08/24/2022 |
08/24/2027 |
Common Stock
|
250,000
(3)
|
$
5.35
|
D
|
|
Option to purchase Common Stock, par value $0.0001
|
08/24/2023 |
08/24/2028 |
Common Stock
|
150,000
(2)
|
$
5.35
|
D
|
|
Option to purchase Common Stock, par value $0.0001
|
08/24/2023 |
08/24/2028 |
Common Stock
|
250,000
(3)
|
$
5.35
|
D
|
|
Option to purchase Common Stock, par value $0.0001
|
08/24/2024 |
08/24/2029 |
Common Stock
|
150,000
(2)
|
$
5.35
|
D
|
|
Option to purchase Common Stock, par value $0.0001
|
08/24/2024 |
08/24/2029 |
Common Stock
|
250,000
(3)
|
$
5.35
|
D
|
|
* |
If the form is filed by more than one reporting person, see Instruction 5(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). |
(1) |
Represents 100,000 shares of restricted common stock granted pursuant to that certain Employment Agreement, dated August 24, 2021, by and between the Company and the Reporting Person (the "Employment Agreement") and evidenced by a Restricted Stock Agreement, of which 40,000 shares vested immediately upon issuance on September 9, 2021, with an additional 20,000 shares of restricted stock to be issued and to vest on each of August 24, 2022, August 24, 2023 and August 24, 2024. Vesting conditioned on the Reporting Person serving on the Board of Directors at any time during the year in which the restricted stock is to vest. |
(2) |
Option granted pursuant to the Employment Agreement and evidenced by a Stock Option Agreement. Option will vest subject to the Employment Agreement remaining in full force and effect on the vesting date. |
(3) |
Option granted pursuant to the Employment Agreement and evidenced by a Stock Option Agreement. Option will vest subject to (a) the Employment Agreement remaining in full force and effect on the vesting date, and (b) the satisfaction of certain performance criteria set forth in the Employment Agreement. |