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