Peraso (PRSO) Form 4 MoSys / STEPHEN L DOMENIK ownership change

SEC Form 4

FORM 4

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

1. Name and Address of Reporting Person^*

DOMENIK STEPHEN L

(Last) (First) (Middle)

C/O SEVIN ROSEN FUNDS

13455 NOEL RD #1670

(Street)

DALLAS TX 75240

(City) (State) (Zip)

2. Issuer Name and Ticker or Trading Symbol
MoSys, Inc. [ MOSY ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
	Officer (give title below)	Other (specify below)

3. Date of Earliest Transaction (Month/Day/Year)
10/13/2017

4. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	3. Transaction Code (Instr. 8)		4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5)			5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)	6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
			Code	V	Amount	(A) or (D)	Price

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	4. Transaction Code (Instr. 8)		5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)		6. Date Exercisable and Expiration Date (Month/Day/Year)		7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)		8. Price of Derivative Security (Instr. 5)	9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)	10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
				Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Option to purchase common stock	$5.3	10/13/2017		J			4,000	(1)	07/22/2022	Common Stock	4,000	(1)	0	D
Option to purchase common stock	$17	10/13/2017		J			4,000	(2)	07/16/2021	Common Stock	4,000	(2)	0	D
Option to purchase common stock	$31	10/13/2017		J			4,000	(3)	07/18/2020	Common Stock	4,000	(3)	0	D
Option to purchase common stock	$41.9	10/13/2017		J			4,000	(4)	07/18/2019	Common Stock	4,000	(4)	0	D
Option to purchase common stock	$30.9	10/13/2017		J			12,000	(5)	07/19/2018	Common Stock	12,000	(5)	0	D
Option to purchase common stock	$30.9	10/13/2017		J			2,000	(6)	07/19/2018	Common Stock	2,000	(6)	0	D

Explanation of Responses:

1. On October 13, 2017, the reporting person and the Company agreed to cancel a stock option granted on July 22, 2016 to purchase 4,000 shares of common stock. The option was previously reported on a Form 4 filed with the SEC on July 26, 2016. The canceled option was exercisable in full as of July 22, 2017 . Shares and price have been adjusted for to reflect 1-for-10 reverse stock split effected in February 2017.

2. On October 13, 2017, the reporting person and the Company agreed to cancel a stock option granted on July 16, 2015 to purchase 4,000 shares of common stock. The option was previously reported on a Form 4 filed with the SEC on July 20, 2015. The canceled option was exercisable in full as of July 16, 2016. Shares and price have been adjusted for to reflect 1-for-10 reverse stock split effected in February 2017.

3. On October 13, 2017, the reporting person and the Company agreed to cancel a stock option granted on July 18, 2014 to purchase 4,000 shares of common stock. The option was previously reported on a Form 4 filed with the SEC on July 22, 2014. The canceled option was exercisable in full as of July 18, 2015 . Shares and price have been adjusted for to reflect 1-for-10 reverse stock split effected in February 2017.

4. On October 13, 2017, the reporting person and the Company agreed to cancel a stock option granted on July 18, 2013 to purchase 4,000 shares of common stock. The option was previously reported on a Form 4 filed with the SEC July 19, 2013. The canceled option was exercisable in full as of July 18, 2014 . Shares and price have been adjusted for to reflect 1-for-10 reverse stock split effected in February 2017.

5. On October 13, 2017, the reporting person and the Company agreed to cancel a stock option granted on July 19, 2012 to purchase 12,000 shares of common stock. The option was previously reported on a Form 4 filed with the SEC on July 20, 2012. The canceled option was exercisable in full as of July 19, 2013. Shares and price have been adjusted for to reflect 1-for-10 reverse stock split effected in February 2017.

6. On October 13, 2017, the reporting person and the Company agreed to cancel a stock option granted on July 19, 2012 to purchase 2,000 shares of common stock. The option was previously reported on a Form 4 filed with the SEC on July 20, 2012. The canceled option was exercisable in full as of July 19, 2013 . Shares and price have been adjusted for to reflect 1-for-10 reverse stock split effected in February 2017.

	C.Leitner by power of attny	10/16/2017
	** Signature of Reporting Person	Date
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