| 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)
| 2. Date of Event Requiring Statement (Month/Day/Year) 09/14/2021 | 3. Issuer Name and Ticker or Trading Symbol PROCEPT BioRobotics Corp [ PRCT ] | |||||||||||||
| 4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
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) |
| Common Stock | 43,859 | D | |
| 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 | ||||
| Stock Option (Right to Buy) | (1) | 04/05/2029 | Common Stock | 145,496 | 4.56 | D | |
| Stock Option (Right to Buy) | (2) | 12/16/2030 | Common Stock | 31,578 | 5.1775 | D | |
| Stock Option (Right to Buy) | (3) | 12/16/2030 | Common Stock | 31,578 | 5.1775 | D | |
| Stock Option (Right to Buy) | (4) | 06/22/2031 | Common Stock | 86,315 | 7.2675 | D | |
| Explanation of Responses: |
| 1. The Stock option was granted on April 5, 2019 and vests 10/46th on the ten month anniversary of the vesting commencement date of March 25, 2019 and the remaining vest monthly over a three year period thereafter, subject continued employment or service to the Issuer through the applicable vesting date. |
| 2. The Stock option was granted on December 16, 2020 and vests on each monthly anniversary of the grant date over a four year period, subject continued employment or service to the Issuer through the applicable vesting date. |
| 3. The Stock option was granted on December 16, 2020 and vests 25% on the first anniversary of the grant date and the remainder vests on each monthly anniversary over a three year period thereafter, subject continued employment or service to the Issuer through the applicable vesting date. |
| 4. The Stock option was granted on June 22, 2021 and vests 25% on the six month anniversary of the grant date and the remainder vests on each monthly anniversary over a four year period thereafter, subject continued employment or service to the Issuer through the applicable vesting date. |
| Remarks: |
| Remarks: Exhibit List: Exhibit 24 - Power of Attorney |
| /s/ Alaleh Nouri, Attorney-in-Fact for Hisham Shiblaq | 09/14/2021 | |
| ** 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. | ||
