QT Imaging Holdings Inc.

11/14/2024 | Press release | Distributed by Public on 11/14/2024 20:04

Statement of Changes in Beneficial Ownership - Form 4

Ownership Submission
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
OMB APPROVAL
OMB Number: 3235-0287 Estimated average burden hours per response... 0.5
(Print or Type Responses)
1. Name and Address of Reporting Person *
Katz Avi S
2. Issuer Name and Ticker or Trading Symbol
QT IMAGING HOLDINGS, INC. [QTI] 		5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
Chairman
(Last) (First) (Middle)
C/O QT IMAGING HOLDINGS, INC., 3 HAMILTON LANDING, SUITE 160 		3. Date of Earliest Transaction (Month/Day/Year)
11/12/2024
(Street)
NOVATO, CA 94949 		4. If Amendment, Date Original Filed (Month/Day/Year)
 6. Individual or Joint/Group Filing (Check Applicable Line)
___ Form filed by One Reporting Person
_X_ 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 11/12/2024 P(1) 2,671,232 A $0.584 2,671,232 I By GigAcquisitions5, LLC(2)
Common Stock 11/12/2024 P 470,890 A $0.584 657,960 D
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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. SEC 1474 (9-02)
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
Subscription Warrants (right to buy) $0.672 11/12/2024 P 2,671,232 05/12/2025 05/12/2030 Common Stock 2,671,232 $0.672 2,671,232 I By GigAcquisitions5, LLC(2)
Subscription Warrants (right to buy) $0.672 11/12/2024 P 470,890 05/12/2025 05/12/2030 Common Stock 470,890 $0.672 470,890 D

Reporting Owners

Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Katz Avi S
C/O QT IMAGING HOLDINGS, INC.
3 HAMILTON LANDING, SUITE 160
NOVATO, CA 94949 		X Chairman
GigAcquisitions5, LLC
C/O QT IMAGING HOLDINGS, INC.
3 HAMILTON LANDING, SUITE 160
NOVATO, CA 94949 		X

Signatures

/s/ Dr. Avi S. Katz 11/14/2024
**Signature of Reporting Person Date
/s/ Dr. Avi S. Katz, Managing Member 11/14/2024
**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) The shares shown were issued in exchange for principal under the Twelfth Amended and Restated Promissory Note (the "Promissory Note") of the Issuer held by GigAcqusitions5, LLC (the "Sponsor"), which Promissory Note was surrendered by the Sponsor for cancellation.
(2) The Common Stock is held directly by the Sponsor. The shares held by the Sponsor are beneficially owned by Dr. Katz. Dr. Katz is also the Manager of the Sponsor, who has sole voting and dispositive power over the shares held by the Sponsor.
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.