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*
HOWARD IVAN

(Last) (First) (Middle)
104 COOPER COURT

(Street)
LOS GATOS CA 95032

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
04/26/2022
3. Issuer Name and Ticker or Trading Symbol
Tenon Medical, Inc. [ TNON ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
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 65,918 I See footnote(1)
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
Stock Options 06/19/2014 06/19/2024 Common Stock 13,669 $0.62 I See footnote(2)
Explanation of Responses:
1. The shares are 25% of the Tenon Medical, Inc. common stock held by TCTIG, LLC for which Ivan Howard has a 25% equity interest therein and has control over how TCTIG, LLC will vote 25% of the common stock held by TCTIG, LLC
2. Option shares held by TCTIG, LLC for which Ivan Howard has a 25% equity interest therein and has control over how TCTIG, LLC will vote 25% of the shares of common stock held by TCTIG, LLC. TCTIG, LLC was granted an option to purchase 109,353 shares (or 54,677 shares after the 1-for-2 reverse stock split was effectuated on April 6, 2022) of common stock at an exercise price of $0.31 (or $0.62 post-split) per share with a grant date of June 19, 2014, which fully vested upon issuance.
/s/ Ivan Howard 04/26/2022
** 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 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).
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