UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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. |
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) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Options (right to buy) | (1) | 11/01/2022 | Common Stock | 5,533 (2) | $ 15 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Wager Michael 100 BURTT ROAD, SUITE 115 ANDOVER, MA 01810 |
Chief Strategy Officer |
/s/ Lisa Wager, by Power of Attorney | 03/04/2022 | |
**Signature of Reporting Person | Date |
* | 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) | Options to purchase 83,000 shares of common stock were granted on 10/30/2020, which converted to Options to purchase 8,300 shares of common stock on 4/27/2021 when the Issuer effected a 10-for-1 reverse stock split. The Options were scheduled to vest monthly in 12 equal increments over one year in exchange for certain consulting services, subject to Wager continuing to provide such services to the Issuer through each such vesting date. Subsequently, Wager discontinued such services, and 2,767 of the 8,300 options were forfeited based on the vesting terms, with 5,533 vested options remaining. |
(2) | The original form 3 has been amended to correct the number of options forfeited and remaining upon Wager's discontinuation of consulting services. All vested options are exercisable. |