0001062993-24-013611.txt : 20240709
0001062993-24-013611.hdr.sgml : 20240709
20240709204423
ACCESSION NUMBER: 0001062993-24-013611
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20240703
FILED AS OF DATE: 20240709
DATE AS OF CHANGE: 20240709
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: GREENE JAMES S
CENTRAL INDEX KEY: 0001116229
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40839
FILM NUMBER: 241108506
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: QT IMAGING HOLDINGS, INC.
CENTRAL INDEX KEY: 0001844505
STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845]
ORGANIZATION NAME: 08 Industrial Applications and Services
IRS NUMBER: 861728920
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 3 HAMILTON LANDING
STREET 2: SUITE 160
CITY: NOVATO
STATE: CA
ZIP: 94949
BUSINESS PHONE: 415-842-7250
MAIL ADDRESS:
STREET 1: 3 HAMILTON LANDING
STREET 2: SUITE 160
CITY: NOVATO
STATE: CA
ZIP: 94949
FORMER COMPANY:
FORMER CONFORMED NAME: GigCapital5, Inc.
DATE OF NAME CHANGE: 20210204
4
1
form4.xml
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
X0508
4
2024-07-03
0001844505
QT IMAGING HOLDINGS, INC.
QTI
0001116229
GREENE JAMES S
C/O UPHEALTH, INC.
14000 S. MILITARY TRAIL #203
DELRAY BEACH
FL
33484
1
0
0
0
0
Common Stock
200000
I
By Sky D Ventures, LLC
Stock Option (right to buy)
0.748
2024-07-03
4
A
0
40000
0
A
2034-07-03
Common Stock
40000
40000
D
The Common Stock is held directly by Sky D Ventures, LLC. The shares held by Sky D Ventures, LLC are beneficially owned by Mr. Greene, the Issuer's member of the Board of Directors. Mr. Greene is also the Managing Member of Sky D Ventures, LLC, who has sole voting and dispositive power over the shares held by Sky D Ventures, LLC.
One-third of the option will vest on February 15, 2025, and the remaining two thirds will vest in eight equal quarterly installments on each subsequent May 15, August 15, November 15 and February 15, such that the option will be fully vested on February 15, 2027, subject to the Reporting Person's continued service to the Issuer, through each vesting date.
/s/ James S. Greene
2024-07-09