SEC Form 3
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 06/04/2021 |
3. Issuer Name and Ticker or Trading Symbol
NANOMIX Corp [ NNMX ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series C Convertible Preferred Stock | 06/04/2021 | (1) | Common Stock | 6,257,327 | (1) | D | |
Non-Qualified Stock Options (right to buy) | 03/31/2014 | 03/31/2024 | Common Stock | 1,042,844(2) | 0.0013 | D | |
Non-Qualified Stock Options (right to buy) | 04/17/2018 | 04/17/2028 | Common Stock | 8,938.436(2) | 0.0027 | D | |
Non-Qualified Stock Options (right to buy) | 02/18/2019 | 04/17/2028 | Common Stock | 8,938.436(2) | 0.0017 | D | |
Non-Qualified Stock Options (right to buy) | 01/20/2021 | 04/17/2028 | Common Stock | 8,938.436(2) | 0.0017 | D | |
Restricted Stock Unit | (3) | (3) | Common Stock | 21,631,402 | (3) | D |
Explanation of Responses: |
1. Each share of Series C Preferred Stock shall be converted into approximately 6,167 shares of the Issuer's common stock upon the date the Issuer consummates its previously announced one for 173 reverse stock split of its capital stock. |
2. The shares vested upon grant. The shares of common stock and exercise price of the stock options will be adjusted upon the consummation of the Company's previously announced one for 173 reverse stock split of its capital stock. |
3. Each restricted stock unit ("RSU") represents the right to receive one share of common stock upon vesting. The RSUs fully vest over a 3 year period upon the shares of common stock issuable upon vesting are freely tradable by the Reporting Person. The shares of common stock issuable upon vesting of the RSU will be adjusted upon the consummation of the Company's previously announced one for 173 reverse stock split of its capital stock. |
/s/ Greg Schiffman | 12/21/2022 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* 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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |