4//SEC Filing
Ernst Jennifer 4
Accession 0001104659-21-139507
CIK 0001787740other
Filed
Nov 14, 7:00 PM ET
Accepted
Nov 15, 9:11 PM ET
Size
11.5 KB
Accession
0001104659-21-139507
Insider Transaction Report
Form 4
Ernst Jennifer
DirectorChief Executive Officer
Transactions
- Conversion
Series Seed-2 Convertible Preferred Stock
2021-11-12−5,566→ 0 totalFrom: 2021-03-01→ Common Stock (1,391 underlying) - Conversion
Common Stock
2021-11-12+1,391→ 1,172,891 total - Conversion
Convertible Promissory Note
2021-11-12→ 0 totalExercise: $3.75→ Common Stock (26,986 underlying) - Conversion
Common Stock
2021-11-12+26,986→ 1,199,877 total
Footnotes (3)
- [F1]The shares 5,566 shares of Series Seed-2 Convertible Preferred Stock held by the Reporting Person automatically converted into 1,391 shares of the Issuer's common stock on November 12, 2021 in connection with the Issuer's initial public offering (the "IPO"). The Series Seed-2 Convertible Preferred Stock had no expiration date.
- [F2]On November 12, 2021, in connection with the Issuer's IPO, the outstanding principal and accrued but unpaid interest of the Convertible Promissory Note (the "Note"), amounting to $100,000 and $1,200, respectively, automatically converted into an aggregate of 26,986 shares of the Issuer's common stock at a conversion price of $3.75 per share, which conversion price was equal to the IPO price per share of the issuer's common stock, less a 25% discount.
- [F3]The Note was scheduled to mature on June 1, 2023.
Documents
Issuer
Tivic Health Systems, Inc.
CIK 0001787740
Entity typeother
Related Parties
1- filerCIK 0001889915
Filing Metadata
- Form type
- 4
- Filed
- Nov 14, 7:00 PM ET
- Accepted
- Nov 15, 9:11 PM ET
- Size
- 11.5 KB