SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Williams Gregg

(Last) (First) (Middle)
13170 TELFAIR AVENUE

(Street)
SYLMAR CA 91342

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Vivani Medical, Inc. [ VANI ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
08/30/2022
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 08/30/2022 J(1) 7,891,098 A $0 11,636,814 I See footnote(3)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Warrant $3.147 08/30/2022 J(2) 190,650 08/30/2022 03/03/2025 common stock 190,650 $0.00 190,650 I Trust
Warrant $3.147 08/30/2022 J(2) 423,669 08/30/2022 10/23/2023 common stock 423,669 $0.00 423,669 I Trust
Warrant $3.147 08/30/2022 J(2) 158,875 08/30/2022 03/18/2024 common stock 158,875 $0.00 158,875 I Trust
Warrant $3.147 08/30/2022 J(2) 476,631 08/30/2022 04/15/2024 common stock 476,631 $0.00 476,631 I Trust
Warrant $3.147 08/30/2022 J(2) 190,650 08/30/2022 07/02/2024 common stock 190,650 $0.00 190,650 I Trust
Warrant $3.147 08/30/2022 J(2) 190,650 08/30/2022 07/31/2024 common stock 190,650 $0.00 190,650 I Trust
Warrant $3.147 08/30/2022 J(2) 190,650 08/30/2022 09/03/2024 common stock 190,650 $0.00 190,650 I Trust
Warrant $3.147 08/30/2022 J(2) 190,650 08/30/2022 10/01/2024 common stock 190,650 $0.00 190,650 I Trust
Warrant $3.147 08/30/2022 J(2) 190,650 08/30/2022 11/04/2024 common stock 190,650 $0.00 190,650 I Trust
Warrant $3.147 08/30/2022 J(2) 190,650 08/30/2022 12/03/2024 common stock 190,650 $0.00 190,650 I Trust
Warrant $3.147 08/30/2022 J(2) 190,650 08/30/2022 01/02/2025 common stock 190,650 $0.00 190,650 I Trust
Warrant $3.147 08/30/2022 J(2) 190,650 08/30/2022 01/31/2025 common stock 190,650 $0.00 190,650 I Trust
Warrant $3.147 08/30/2022 J(2) 190,650 08/30/2022 04/01/2025 common stock 190,650 $0.00 190,650 I Trust
Warrant $3.147 08/30/2022 J(2) 127,097 08/30/2022 06/03/2025 common stock 127,097 $0.00 127,097 I Trust
Warrant $3.147 08/30/2022 J(2) 127,097 08/30/2022 07/01/2025 common stock 127,097 $0.00 127,097 I Trust
Warrant $3.147 08/30/2022 J(2) 127,097 08/30/2022 08/31/2025 common stock 127,097 $0.00 127,097 I Trust
Warrant $3.147 08/30/2022 J(2) 60,530 08/30/2022 10/02/2025 common stock 60,530 $0.00 60,530 I Trust
Warrant $3.147 08/30/2022 J(2) 79,505 08/30/2022 12/07/2025 common stock 79,505 $0.00 79,505 I Trust
Warrant $3.147 08/30/2022 J(2) 109,623 08/30/2022 12/08/2025 common stock 109,623 $0.00 109,623 I Trust
Warrant $3.147 08/30/2022 J(2) 317,753 08/30/2022 02/23/2026 common stock 317,753 $0.00 317,753 I Trust
Warrant $3.147 08/30/2022 J(2) 329,891 08/30/2022 03/31/2026 common stock 329,891 $0.00 329,891 I Trust
Warrant $3.147 08/30/2022 J(2) 329,891 08/30/2022 05/24/2026 common stock 329,891 $0.00 329,891 I Trust
Warrant $3.147 08/30/2022 J(2) 329,891 08/30/2022 06/30/2026 common stock 329,891 $0.00 329,891 I Trust
Warrant $3.147 08/30/2022 J(2) 329,891 08/30/2022 07/23/2026 common stock 329,891 $0.00 329,891 I Trust
Warrant $3.147 08/30/2022 J(2) 329,891 08/30/2022 08/27/2026 common stock 329,891 $0.00 329,891 I Trust
Warrant $3.147 08/30/2022 J(2) 329,891 08/30/2022 09/29/2026 common stock 329,891 $0.00 329,891 I Trust
Warrant $3.147 08/30/2022 J(2) 329,891 08/30/2022 10/29/2026 common stock 329,891 $0.00 329,891 I Trust
Warrant $3.147 08/30/2022 J(2) 506,797 08/30/2022 11/29/2026 common stock 506,797 $0.00 506,797 I Trust
Warrant $3.147 08/30/2022 J(2) 506,794 08/30/2022 12/28/2026 common stock 506,794 $0.00 506,794 I Trust
Explanation of Responses:
1. Represents shares of common stock issued in the acquisition transaction of Nano Precision Medical Inc. consummated on August 30, 2022.
2. Represents warrants to purchase shares of common stock assumed on the effective date of the acquisition of Nano Precision medical, Inc., consummated on August 30, 2022, pursuant to the Agreement and Plan of Merger dated February 4, 2022.
3. After giving effect to the transactions reported on this Form 4, shares beneficially owned by Mr. Williams include (i) 9,511,062 shares of common stock and warrants to purchase 7,808,405 shares of common stock owned by GW Trust, (ii) 1,212,856 shares of common stock and warrants to purchase 1,151,012 shares of common stock owned by Williams International Co. LLC (iii) 181,587 shares of common stock owned by Sam Williams Family Investments LLC and (iv) 731,309 shares of common stock and warrants to purchase 287,753 shares of common stock owned by GST. Greg Williams has voting and dispositive power over all of these shares.
/s/ Gregg Williams 09/01/2022
** 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 4 (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).
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