SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL 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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1. Name and Address of Reporting Person*
Dorn Jessy Dana

(Last) (First) (Middle)
12744 SAN FERNANDO ROAD
SUITE 400

(Street)
SYLMAR CA 91342

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/25/2019
3. Issuer Name and Ticker or Trading Symbol
SECOND SIGHT MEDICAL PRODUCTS INC [ EYES ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
VP-Clin & Scientific Affairs
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 1,458 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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: 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
Non-Qualified Stock Option(right to buy) 02/01/2011(1) 02/01/2020 Common Stock 405 5 D
Non-Qualified Stock Option(right to buy) 06/01/2011(1) 06/01/2020 Common Stock 1,000 5 D
Non-Qualified Stock Option(right to buy) 04/01/2015(1) 04/01/2024 Common Stock 5,250 5 D
Non-Qualified Stock Option(right to buy) 03/25/2016(1) 03/25/2025 Common Stock 3,750 13.09 D
Non-Qualified Stock Option(right to buy) 05/15/2016(2) 05/15/2025 Common Stock 20,000 12.46 D
Non-Qualified Stock Option(right to buy) 01/14/2017(2) 01/14/2026 Common Stock 15,000 4.18 D
Non-Qualified Stock Option(right to buy) 01/21/2017(2) 01/21/2026 Common Stock 9,210 4.1 D
Non-Qualified Stock Option(right to buy) 01/18/2018(2) 01/18/2027 Common Stock 20,000 1.73 D
Non-Qualified Stock Option(right to buy) 01/02/2019(2) 01/02/2028 Common Stock 20,000 2.01 D
Non-Qualified Stock Option(right to buy) 02/23/2019(3) 01/23/2029 Common Stock 32,800 0.815 D
Non-Qualified Stock Option(right to buy) 07/04/2019(3) 06/04/2029 Common Stock 75,000 0.7088 D
Explanation of Responses:
1. The stock options have a 10-year term and vest over five years from the grant date in equal annual installments, subject to continuous employment, such that the total number shall be fully vested on the five-year anniversary of the transaction date.
2. The stock options have a 10-year term and vest 25% on the first anniversary and then in equal quarterly installments, subject to continuous employment, such that the total number shall be fully vested on the four-year anniversary of the transaction date.
3. The stock options have a 10-year term and vest over four years from the grant date in equal monthly installments, subject to continuous employment, such that the total number shall be fully vested on the four-year anniversary of the transaction date.
Remarks:
/s/ John T. Blake, Attorney-in-fact 10/02/2019
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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 Number.