Profusa Inc.

08/19/2026 | Press release | Distributed by Public on 08/19/2026 18:14

Statement of Changes in Beneficial Ownership (Form 4)

FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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.
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN 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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(Print or Type Responses)
1. Name and Address of Reporting Person *
STOVER JACK E
2. Issuer Name and Ticker or Trading Symbol
Profusa, Inc. [PFSA]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
Chief Executive Officer
(Last) (First) (Middle)
626 BANCROFT WAY, SUITE A
3. Date of Earliest Transaction (Month/Day/Year)
08/12/2026
(Street)
BERKELEY, CA 94710
4. If Amendment, Date Original Filed (Month/Day/Year)
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)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction 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 08/12/2026 C 301,991(1) A $4.28(2) 301,991(1) I By NorthView Sponsor I LLC(3)
Common Stock 73 D
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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
(Month/Day/Year)
7. Title and Amount of Underlying Securities
(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
Convertible Promissory Note $4.28(2) 08/12/2026 C $1,292,521(4) 05/04/2026(5) 12/31/2026 Common Stock 301,991(1) $ 0 $577,275(6) I By NorthView Sponsor I LLC(3)

Reporting Owners

Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
STOVER JACK E
626 BANCROFT WAY, SUITE A
BERKELEY, CA 94710
Chief Executive Officer

Signatures

/s/ Jack Stover 08/19/2026
**Signature of Reporting Person Date

Explanation of Responses:

* 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).
(1) On August 12, 2026, 1,207,964 shares of Common Stock were issued upon conversion of a portion of the Convertible Promissory Note. Following a 1-for-4 reverse stock split effected after the conversion, the number of shares held became 301,991.
(2) The conversion price is equal to the higher of (i) $1.07 and (ii) the closing price of the Common Stock on the trading day immediately preceding the delivery of the Conversion Notice, as reported on The Nasdaq Stock Market, pursuant to Amendment No. 3 to the Note Modification and Conversion Agreement dated August 12, 2026. The pre-split conversion price of $1.07 per share is equivalent to $4.28 per share on a post-split basis following the 1-for-4 reverse stock split.
(3) Jack Stover is a manager of NorthView Sponsor I LLC and may be deemed to share beneficial ownership of the securities held by NorthView Sponsor I LLC. Mr. Stover disclaims beneficial ownership of such securities except to the extent of his pecuniary interest therein.
(4) Represents the conversion of $1,292,521 principal amount of the Convertible Promissory Note into 1,207,964 shares of Common Stock (301,991 shares on a post-split basis), reflecting conversion at the $1.07 per share ($4.28 per share on a post-split basis) price pursuant to the Conversion Notice dated August 12, 2026.
(5) The Note became convertible on May 4, 2026 (the Registration Effective Date), pursuant to Section 2.1 of the Note Modification and Conversion Agreement dated April 24, 2026.
(6) Represents the remaining principal balance of the Note following conversion.
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
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