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) 02/14/2023 |
3. Issuer Name and Ticker or Trading Symbol
NYIAX, INC. [ NYX ] |
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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 | ||||
Stock Options(1) | (2) | 06/18/2028 | Common Stock | 25,000 | 3.3 | D | |
Stock Options(3) | (2) | 04/01/2030 | Common Stock | 5,000 | 3.3 | D | |
Stock Options(4) | (2) | 09/28/2030 | Common Stock | 20,000 | 3.3 | D | |
Stock Options(5) | (2) | 09/28/2030 | Common Stock | 5,000 | 4.3 | D | |
Stock Options(6) | (7) | 11/01/2032 | Common Stock | 25,000 | 5.5 | D | |
Stock Options(8) | (9) | 04/01/2032 | Common Stock | 1,500 | 5.5 | D |
Explanation of Responses: |
1. On June 18, 2018, the Reporting Person was issued stock options to purchase 25,000 shares of common stock of the Issuer with 8,334 options vesting immediately as of October 18, 2018 and 16,666 options vesting in 1/24 equal increments per month from October 18, 2018. |
2. These options are fully vested and exercisable. |
3. On April 1, 2020, the Reporting Person was issued stock options to purchase 5,000 shares of common stock of the Issuer with all 5,000 options vesting as of June 1, 2020. |
4. On October 1, 2020, the Reporting Person was issued stock options to purchase 20,000 shares of common stock of the Issuer with 1,666 options vesting immediately as of October 1, 2020 and 18,333 options vesting in 1,666 options per month increments thereafter. |
5. On October 1, 2020, the Reporting Person was issued stock options to purchase 5,000 shares of common stock of the Issuer with 416.66 options vesting immediately as of October 1, 2020 and approximately 4,583 options vesting in 416.66 options per month increments thereafter. |
6. On April 27, 2022, the Reporting Person was issued stock options to purchase 25,000 shares of common stock of the Issuer vesting (at a rate of 1/48 of the total award of 25,000 options) over a four-year period with twelve months vesting on November 11, 2022 and vesting continuing monthly thereafter, until the stock option award is fully vested. |
7. The stock options vest (at a rate of 1/48 of the total award of 25,000 options) over a four-year period with twelve months vesting on November 11, 2022 and vesting continuing monthly thereafter, until fully vested. |
8. On April 27, 2022, the Reporting Person was issued stock options to purchase 1,500 shares of common stock of the Issuer vesting (at a rate of 1/48 of the total award of 1,500 options) over a four-year period with twelve months vesting on January 1, 2023 and vesting continuing monthly thereafter, until the stock option award is fully vested. |
9. The stock options vest (at a rate of 1/48 of the total award of 1,500 options) over a four-year period with twelve months vesting on January 1, 2023 and vesting continuing monthly thereafter, until fully vested. |
/s/ Vladislav Kuzemchik | 02/15/2023 | |
** 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. |