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) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Convertible Promissory Note
|
(1)
|
(1)
|
Common Stock
|
65,653
|
$
(1)
|
I
|
See Footnote
(2)
|
Stock option (right to buy)
|
(3)
|
05/12/2030 |
Common Stock
|
27,272
|
$
0.28
|
D
|
|
Stock option (right to buy)
|
(4)
|
06/15/2031 |
Common Stock
|
181,818
|
$
2.5
|
D
|
|
* |
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 $275,742.60 of outstanding principal and interest calculated through November 10, 2021. The note will convert into 65,653 shares of Common Stock upon the closing of the Issuer's initial public offering of Common Stock (the "IPO"). |
(2) |
The Convertible Promissory Note is held by the Ferrari Living Trust, of which the Reporting Person is the trustee. |
(3) |
Five forty-eighth of the shares vested on date of grant, May 12, 2020, one forty-eighth of the shares subject to the option vested June 11, 2020 and each one-month anniversary thereafter, subject to the Reporting Person continuing as a service provider through each such date. |
(4) |
One forty-eighth of the shares subject to the option vest on July 15, 2021 and each one-month anniversary thereafter, subject to the Reporting Person continuing as a service provider through each such date. |