3: Initial statement of beneficial ownership of securities
Published on August 11, 2016
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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 | ||||
| Series A Preferred Stock | (2) | (2) | Common Stock | 27,826 | $ (2) | I | See Footnote (1) |
| Series B Preferred Stock | (2) | (2) | Common Stock | 82,416 | $ (2) | I | See Footnote (1) |
| Series C Preferred Stock | (2) | (2) | Common Stock | 39,697 | $ (2) | I | See Footnote (1) |
| Series D Preferred Stock | (2) | (2) | Common Stock | 25,537 | $ (2) | D | |
| Series D Preferred Stock | (2) | (2) | Common Stock | 12,309 | $ (2) | I | See Footnote (1) |
| Series E Preferred Stock | (2) | (2) | Common Stock | 9,360 | $ (2) | D | |
| Series F Preferred Stock | (2) | (2) | Common Stock | 3,846 | $ (2) | D | |
| Series G Preferred Stock | (2) | (2) | Common Stock | 8,322 | $ (2) | D | |
| Stock Option (Right to Buy) | (3) | 01/24/2017 | Common Stock | 2,000 | $ 2.2 | D | |
| Stock Option (Right to Buy) | (3) | 12/10/2017 | Common Stock | 2,000 | $ 2.2 | D | |
| Stock Option (Right to Buy) | (3) | 03/17/2019 | Common Stock | 2,000 | $ 2.6 | D | |
| Stock Option (Right to Buy) | (3) | 12/03/2019 | Common Stock | 2,000 | $ 2.6 | D | |
| Stock Option (Right to Buy) | (3) | 01/18/2021 | Common Stock | 2,000 | $ 2.6 | D | |
| Stock Option (Right to Buy) | (3) | 06/12/2023 | Common Stock | 4,000 | $ 2.3 | D | |
| Stock Option (Right to Buy) | (3) | 05/12/2024 | Common Stock | 2,000 | $ 3.1 | D | |
| Stock Option (Right to Buy) | (3) | 06/11/2025 | Common Stock | 30,347 | $ 1.6 | D | |
| Stock Option (Right to Buy) | (3) | 05/24/2016 | Common Stock | 7,832 | $ 1.9 | D | |
| Dividend Right | (4) | (4) | Common Stock | 40,075 | $ (4) | D | |
| Dividend Right | (4) | (4) | Common Stock | 33,972 | $ (4) | I | See Footnote (1) |
Reporting Owners
| Reporting Owner Name / Address | Relationships | |||
| Director | 10% Owner | Officer | Other | |
| Toscanini Arthur M. C/O AIRGAIN, INC. 3611 VALLEY CENTRE DRIVE, SUITE 150 SAN DIEGO, CA 92130 |
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Signatures
| /s/ Arthur M. Toscanini | 08/11/2016 | |
| **Signature of Reporting Person | Date |
Explanation of Responses:
| * | 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) | Represents shares of common stock held by Gen 3 Partners, Inc. ("Gen 3 Partners"). Mr. Toscanini may be deemed to share beneficial ownership of the shares held by Gen 3 Partners in his capacity as a director of Gen 3 Partners. Mr. Toscanini disclaims such beneficial ownership extent to the extent of his pecuniary interest therein. |
| (2) | The preferred stock is convertible at any time, at the holder's election and has no expiration date. The preferred stock will automatically convert into common stock upon the closing of the Issuer's initial public offering. |
| (3) | The option is fully vested. |
| (4) | The dividend rights are payable in cash or shares of common stock at the Issuer's election immediately upon the closing of the Issuer's initial public offering. |