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)
| 2. Date of Event Requiring Statement (Month/Day/Year) 07/27/2022 | 3. Issuer Name and Ticker or Trading Symbol MAIA Biotechnology, Inc. [ MAIA ] | |||||||||||||
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 | 21,511(1) | 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 Options | (2) | 11/30/2029 | Common Stock | 200,000 | 1.8 | D | |
Stock Options | (3) | 11/30/2029 | Common Stock | 58,000 | 1.8 | D | |
Stock Options | (4) | 04/01/2030 | Common Stock | 54,000 | 1.8 | D | |
Stock Options | (5) | 11/02/2030 | Common Stock | 236,493 | 1.8 | D | |
Stock Options | (6) | 12/31/2030 | Common Stock | 23,695 | 1.8 | D | |
Stock Options | (7) | 04/15/2031 | Common Stock | 164,662 | 1.83 | D | |
Stock Options | (8) | 04/15/2031 | Common Stock | 78,413 | 1.83 | D | |
Stock Options | (9) | 03/31/2031 | Common Stock | 23,078 | 1.83 | D | |
Stock Options | (10) | 04/15/2031 | Common Stock | 50,000 | 1.83 | D | |
Stock Options | (11) | 06/30/2031 | Common Stock | 7,529 | 1.83 | D |
Explanation of Responses: |
1. Mr. Gryaznov beneficially owns 21,511 shares of common stock. |
2. Represents an option to purchase shares of Common Stock granted pursuant to the 2018 Stock Option Plan. These options fully vested on .December 1, 2019. |
3. Represents an option to purchase shares of Common Stock granted pursuant to the 2018 Stock Option Plan. These options vested in four equal monthly installments on December 1, 2019. |
4. Represents an option to purchase shares of Common Stock granted pursuant to the 2018 Stock Option Plan. 6,055 of these options vested on April 30, 2020 and 47,945 of these options vested on January 1, 2021. |
5. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options fully vested on November 3, 2020. |
6. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options vested in 90 equal daily instalments beginning on January 1, 2021. |
7. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options fully vested on May 20, 2021. |
8. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options fully vested on May 20, 2021. |
9. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options vested in 90 equal daily instalments beginning on April 2, 2021. |
10. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options vested in 36 equal monthly instalments beginning on January 1, 2021. |
11. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options fully vested on July 1, 2021. |
Remarks: |
/s/ Sergei M. Gryaznov | 07/27/2022 | |
** 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. |