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 | |
Sato Kaijiro C/O CROWN ELECTROKINETICS CORP. 1110 NE CIRCLE BLVD. CORVALLIS, OR 97330 |
Co-President and CMO |
/s/ Kaijiro Sato | 02/26/2021 | |
**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) | Granted pursuant to the Issuer's 2020 Employee Incentive Plan. |
(2) | Consists of 400,000 shares of restricted stock, vesting in equal monthly installments over a period of 36 months. The Issuer and the Reporting Person have agreed to defer delivery of all vested shares until the 60th month following February [ ], 2021, subject to the Reporting Person's continued employment with the Issuer. |
(3) | Held by the Reporting Person's wholly-owned entity, Kaizen Reserve, Inc. |