09/17/2025 | Press release | Distributed by Public on 09/17/2025 15:01
FORM 4
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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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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) |
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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Restricted Stock Unit (RSU) | (2) | 09/15/2025 | A | 2,887 | (3) | (3) | Common Stock | 2,887 | $ 0 | 2,887 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Harari Michele C/O CAPSOVISION, INC. 18805 COX AVENUE, SUITE 250 SARATOGA, CA 95070 |
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/s/ Kang-Huai (Johnny) Wang, Attorney-in-Fact for Michele Harari | 09/17/2025 | |
**Signature of Reporting Person | Date |
* | 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 reporting person previously reported 187,000 common stock on a Form 3 filed July 1, 2025. The number of shares reported herein gives effect to a 1-for-3.33 reverse stock split of the Issuer's common stock effected by the Issuer on July 2, 2025 in connection with its initial public offering. |
(2) | Each Restricted Stock Unit (the "RSU") represents a contingent right to receive one share of the Issuer's common stock. |
(3) | These RSUs are scheduled to vest on December 31, 2025 |