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PRCT Procept BioRobotics

Filed: 14 Sep 21, 7:16pm
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*
Zadno Reza

(Last) (First) (Middle)
C/O PROCEPT BIOROBOTICS CORPORATION
900 ISLAND DRIVE

(Street)
REDWOOD CITY CA 94065

(City) (State) (Zip)
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)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President, CEO
5. 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 Beneficially Owned
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 52,631 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Series F Convertible Preferred Stock (1) (1) Common Stock 3,394 (1) D
Stock Option (Right to Buy) (2) 02/20/2030 Common Stock 1,318,258 4.37 D
Stock Option (Right to Buy) (3) 08/10/2020 Common Stock 254,477 5.1775 D
Stock Option (Right to Buy) (4) 06/22/2031 Common Stock 172,630 7.2675 D
Explanation of Responses:
1. Each share of Series A Preferred Stock , Series B Preferred Stock, Series C Preferred Stock, Series D Preferred Stock, Series E Preferred Stock, Series F Preferred Stock and Series G Preferred Stock (collectively, the "Preferred Stock") will convert automatically into one share of Common Stock upon the closing of the Issuer's initial public offering. These shares have no expiration date.
2. The Stock option was granted on February 20, 2020 and vests 25% on the anniversary of the vesting commencement date of February 1, 2020 and the remaining shares vest on each monthly anniversary over a 3 year period thereafter, subject continued employment or service to the Issuer through the applicable vesting date.
3. The Stock option was granted on August 10, 2020 and vests 12.5% on the 6 month anniversary of the vesting commencement date of August 1, 2020 and the remaining shares vest on each monthly anniversary over a 3.5 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 sixth month anniversary of the vesting commencement date of June 22, 2021 and the reaming shares vest on each monthly anniversary over a 4 year period thereafter, subject continued employment or service to the Issuer through the applicable vesting date
Remarks:
Exhibit List: Exhibit 24 - Power of Attorney
/s/ Alaleh Nouri, Attorney-in-Fact for Reza Zadno, MD 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.