SEC Form 4 · accession 0001615774-16-008745

Vivani Medical, Inc. · VANI

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director · 10% Owner

Period of report

Dec 2, 2016

Accepted (ET)

Dec 6, 2016 · 5:37 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001266806

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
COMMON STOCK^F1,F2,F3	Dec 2, 2016	J	32,156	$1.89	A	8,565,127	I	Footnote
COMMON STOCK^F4	holding	—	—		—	16,786	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
WARRANT^F3	$5.00	holding	—	—	—	Jul 31, 2012	Jul 31, 2017	COMMON STOCK	214,921	214,921	I
WARRANT^F3	$5.00	holding	—	—	—	Feb 23, 2013	Feb 28, 2018	COMMON STOCK	240,000	240,000	I

F132,156 shares of common stock issuable to Williams International Co. LLC upon trigger of Long Term Investor Rights (LTIRs) as described in the Company's final prospectus dated November 20, 2014.
F2The closing price of the Company's shares on December 2, 2016, the date on which independent CPA firm determined number of shares issuable on trigger of LTIRs.
F3Of which (i) Gregg Williams 2006 Trust, whose trustee and principal beneficiary is Mr. Williams, owns 2,722,791 shares, (ii) Williams International Co. LLC, whose manager is Mr. Williams, owns 1,484,254 shares and warrants to purchase 240,000 shares, and (iii) Sam Williams Family Investments LLC, whose manager is Mr. Williams, owns 4,358,082 shares and warrants to purchase 214,921 shares.
F4Gives effect to 5,439 shares received by Mr. Williams for his services as member of the Board of the Company and transferred of record to Gregg Williams 2006 Trust.