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