0000899243-21-031833.txt : 20210805 0000899243-21-031833.hdr.sgml : 20210805 20210805195151 ACCESSION NUMBER: 0000899243-21-031833 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210803 FILED AS OF DATE: 20210805 DATE AS OF CHANGE: 20210805 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Wolfen Richard M. CENTRAL INDEX KEY: 0001873830 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40690 FILM NUMBER: 211150192 MAIL ADDRESS: STREET 1: C/O RXSIGHT, INC. STREET 2: 100 COLUMBIA CITY: ALISO VIEJO STATE: CA ZIP: 92656 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: RxSight, Inc. CENTRAL INDEX KEY: 0001111485 STANDARD INDUSTRIAL CLASSIFICATION: OPHTHALMIC GOODS [3851] IRS NUMBER: 943268801 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 100 COLUMBIA STREET STREET 2: SUITE 120 CITY: ALISO VIEJO STATE: CA ZIP: 92656 BUSINESS PHONE: 949-521-7822 MAIL ADDRESS: STREET 1: 100 COLUMBIA STREET STREET 2: SUITE 120 CITY: ALISO VIEJO STATE: CA ZIP: 92656 FORMER COMPANY: FORMER CONFORMED NAME: CALHOUN VISION INC DATE OF NAME CHANGE: 20000410 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-08-03 1 0001111485 RxSight, Inc. RXST 0001873830 Wolfen Richard M. C/O RXSIGHT, INC. 100 COLUMBIA ALISO VIEJO CA 92656 1 0 0 0 Common Stock 2021-08-03 4 C 0 76974 0.00 A 78170 D Common Stock 2021-08-03 4 C 0 1489805 0.00 A 1762074 I See footnote Series A Preferred Stock 2021-08-03 4 C 0 2800 0.00 D Common Stock 2800 0 D Series A Preferred Stock 2021-08-03 4 C 0 11714 0.00 D Common Stock 11714 0 I See footnote Series B Preferred Stock 2021-08-03 4 C 0 2017 0.00 D Common Stock 2017 0 D Series B Preferred Stock 2021-08-03 4 C 0 246054 0.00 D Common Stock 246054 0 I See footnote Series C Preferred Stock 2021-08-03 4 C 0 398810 0.00 D Common Stock 408814 0 I See footnote Series D Preferred Stock 2021-08-03 4 C 0 10807 0.00 D Common Stock 12586 0 D Series D Preferred Stock 2021-08-03 4 C 0 43547 0.00 D Common Stock 50711 0 I See footnote Series E Preferred Stock 2021-08-03 4 C 0 4840 0.00 D Common Stock 5887 0 D Series E Preferred Stock 2021-08-03 4 C 0 18150 0.00 D Common Stock 22077 0 I See footnote Series F Preferred Stock 2021-08-03 4 C 0 154886 0.00 D Common Stock 235499 0 I See footnote Series G Preferred Stock 2021-08-03 4 C 0 42552 0.00 D Common Stock 42552 0 D Series G Preferred Stock 2021-08-03 4 C 0 357227 0.00 D Common Stock 357227 0 I See footnote Series H Preferred Stock 2021-08-03 4 C 0 9680 0.00 D Common Stock 9680 0 D Series H Preferred Stock 2021-08-03 4 C 0 157709 0.00 D Common Stock 157709 0 I See footnote Warrant (right to buy) 12.40 2021-08-03 4 M 0 1452 0.00 D 2017-02-24 Series H Preferred Stock 1452 0 D Series H Preferred Stock 12.40 2021-08-03 4 M 0 1452 0.00 A Common Stock 1452 1452 D Series H Preferred Stock 2021-08-03 4 C 0 1452 0.00 D Common Stock 1452 0 D All shares of the Series A Preferred Stock, par value $0.001 per share, of the Issuer automatically converted on a one-for-one basis to shares of the Issuer's common stock, par value $0.001 per share ("Common Stock") immediately prior to the closing of the Issuer's initial public offering of its Common Stock. Shares held by various trusts and other entities for which the Reporting Person serves as trustee, investment advisor or manager and, in such capacity, has sole voting and dispositive over all such shares. All shares of the Series B Preferred Stock, par value $0.001 per share, of the Issuer automatically converted on a one-for-one basis to shares of the Issuer's common stock, par value $0.001 per share ("Common Stock") immediately prior to the closing of the Issuer's initial public offering of its Common Stock. All shares of the Series C Preferred Stock, par value $0.001 per share, of the Issuer automatically converted on a one-for-1.0251 basis to shares of the Issuer's common stock, par value $0.001 per share ("Common Stock") immediately prior to the closing of the Issuer's initial public offering of its Common Stock. All shares of the Series D Preferred Stock, par value $0.001 per share, of the Issuer automatically converted on a one-for-1.1647 basis to shares of the Issuer's common stock, par value $0.001 per share ("Common Stock") immediately prior to the closing of the Issuer's initial public offering of its Common Stock. All shares of the Series E Preferred Stock, par value $0.001 per share, of the Issuer automatically converted on a one-for-1.2164 basis to shares of the Issuer's common stock, par value $0.001 per share ("Common Stock") immediately prior to the closing of the Issuer's initial public offering of its Common Stock. All shares of the Series F Preferred Stock, par value $0.001 per share, of the Issuer automatically converted on a one-for-1.5205 basis to shares of the Issuer's common stock, par value $0.001 per share ("Common Stock") immediately prior to the closing of the Issuer's initial public offering of its Common Stock. All shares of the Series G Preferred Stock, par value $0.001 per share, of the Issuer automatically converted on a one-for-one basis to shares of the Issuer's common stock, par value $0.001 per share ("Common Stock") immediately prior to the closing of the Issuer's initial public offering of its Common Stock. All shares of the Series H Preferred Stock, par value $0.001 per share, of the Issuer automatically converted on a one-for-one basis to shares of the Issuer's common stock, par value $0.001 per share ("Common Stock") immediately prior to the closing of the Issuer's initial public offering of its Common Stock. The warrant was exercised for Series H Preferred Stock immediately prior to the closing of the Issuer's initial public offering of its Common Stock. The number of shares of Series D Preferred Stock reported as beneficially held by the Reporting Person in the Form 3 filed July 29, 2021 incorrectly allocated the number of shares directly and indirectly held. /s/ Shelley Thunen, as Attorney-in-Fact 2021-08-05