SEC Form 4 · accession 0001615774-17-006983

Vivani Medical, Inc. · VANI

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

Reporting owner

Director · 10% Owner

Period of report

Nov 21, 2017

Accepted (ET)

Nov 24, 2017 · 4:17 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	Nov 21, 2017	P	24,604	$1.1882	A	19,482,572	I	See footnote

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Warrant to Purchase Common^F2	$5.00	holding	—	—	—	Feb 23, 2013	Feb 28, 2018	COMMON STOCK	408,548	408,548	I
Warrant to Purchase Common Stock^F2	$1.47	holding	—	—	—	Mar 13, 2017	Mar 13, 2022	Common Stock	6,802,721	6,802,721	I

F1Sam B Williams 95 GST Trust, a trust of which Mr. Williams is trustee, acquired 24,604 shares of common stock reported on this Form 4 on November 21, 2017 at an average price of $1.1882 per share, in multiple open market transactions at prices ranging from $1.16 to $1.20 inclusive. The reporting person undertakes to provide the issuer or the staff of the SEC, upon request, full information regarding the number of shares acquired at each separate price.
F2Of which, (i) Gregg Williams 2006 Trust, a trust of which Mr. Williams is trustee, owned 13,598,612 shares of common stock and warrants to purchase 6,971,269 shares of common stock, (ii) Williams International Co. LLC, whose manager is Mr. Williams, owns 1,484,254 shares and warrants to purchase 240,000 shares, (iii) Sam Williams Family Investments LLC, whose manager is Mr. Williams, owns 4,358,082 shares (and excludes warrants, with $5.00 exercise price per share, to purchase 214,921 shares, that expired July 31, 2017), and (iv) Sam B Williams 95 GST Trust, owns 41,624 shares common stock following November 21, 2017 purchases.