SEC Form 4 · accession 0001654954-18-009158
BLOOMIA HOLDINGS, INC. · TULP
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jeffrey A Jagerson
Officer — CFO and Treasurer
Period of report
Aug 10, 2018
Accepted (ET)
Aug 14, 2018 · 5:05 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000875355
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Aug 10, 2018 | A | 13,570 | $0.00 | A | 95,570 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (right to buy)F2 | $1.95 | Aug 10, 2018 | A | 13,570 | A | — | Aug 10, 2028 | Common Stock | 13,570 | 13,570 | D |
Explanation of responses
- F1Restricted stock units, each representing a contingent right to receive one share of Issuer common stock, granted under the Insignia Systems, Inc. 2018 Equity Incentive Plan and scheduled to vest and settle in three substantially equal installments on August 10, 2020, 2021 and 2022.
- F2Award scheduled to vest in three substantially equal installments on August 10, 2020, 2021 and 2022.