UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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 control number. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
PIV GP, L.L.C. 4 EMBARCADERO CENTER, SUITE 3950 SAN FRANCISCO, CA 94111 |
X | |||
PIV Fund I, L.P. 4 EMBARCADERO CENTER, SUITE 3950 SAN FRANCISCO, CA 94111 |
X | |||
Gudiksen Mark Stout C/O PIVA CAPITAL, INC. 4 EMBARCADERO CENTER, SUITE 3950 SAN FRANCISCO, CA 94111 |
X |
PIV GP, L.L.C., By /s/ Ricardo Angel, managing member | 10/12/2021 | |
**Signature of Reporting Person | Date | |
PIV Fund I, L.P., By: PIV GP, L.L.C., its general partner, By: /s/ Ricardo Angel, managing member | 10/12/2021 | |
**Signature of Reporting Person | Date | |
/s/ Ricardo Angel, as Attorney-in-Fact for Mark S. Gudiksen | 10/12/2021 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Shares are held by PIV Fund I, L.P. ("PIV-I LP"). PIV GP, L.L.C. ("PIV GP") is the general partner of PIV-I LP and may be deemed to beneficially own the shares held by PIV-I LP. Ricardo Angel is the managing member of PIV GP and Mr. Angel and Mark Stout Gudiksen are the managing partners of Piva Capital Inc., the management company of PIV-I LP, and therefore Messrs. Angel and Gudiksen may be deemed to share voting and investment power over the shares held by PIV-I LP. Each of PIV GP and Mr. Gudiksen disclaims beneficial ownership in these shares except to the extent of its or his respective pecuniary interest therein. Mr. Angel is a director of the Issuer and files separate Section 16 reports. |