0001213900-21-005560.txt : 20210201 0001213900-21-005560.hdr.sgml : 20210201 20210201061157 ACCESSION NUMBER: 0001213900-21-005560 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210128 FILED AS OF DATE: 20210201 DATE AS OF CHANGE: 20210201 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CROXALL DOUGLAS B CENTRAL INDEX KEY: 0001331155 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39924 FILM NUMBER: 21574195 MAIL ADDRESS: STREET 1: 2331 MILL ROAD SUITE 100 CITY: ALEXANDRIA STATE: VA ZIP: 22314 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Crown Electrokinetics Corp. CENTRAL INDEX KEY: 0001761696 STANDARD INDUSTRIAL CLASSIFICATION: ELECTRONIC COMPONENTS, NEC [3679] IRS NUMBER: 475423944 STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 BUSINESS ADDRESS: STREET 1: 1110 NE CIRCLE BLVD CITY: CORVALLIS STATE: OR ZIP: 97330 BUSINESS PHONE: 800-674-3612 MAIL ADDRESS: STREET 1: 1110 NE CIRCLE BLVD CITY: CORVALLIS STATE: OR ZIP: 97330 3 1 ownership.xml X0206 3 2021-01-28 0 0001761696 Crown Electrokinetics Corp. CRKN 0001331155 CROXALL DOUGLAS B C/O CROWN ELECTROKINETICS CORP. 1110 NE CIRCLE BLVD. CORVALLIS OR 97330 0 1 1 0 Chief Executive Officer Common Stock 1829294 I In Trust Call Option 0.15 2028-02-28 Common Stock 166666 D Call Option 1.20 2029-01-17 Common Stock 250000 D Call Option 2.25 2030-04-13 Common Stock 1083333 D Call Option 3.60 2030-12-30 Common Stock 1381967 D Call Option 3.60 2030-12-30 Common Stock 485371 D Consists of 1,302,628 shares of restricted stock, all of which has vested. Granted pursuant to the Issuer's 2016 Equity Incentive Plan. Options to purchase shares of the Issuer's Common Stock have vested and are currently exercisable. Options to purchase shares of the Issuer Common Stock granted on December 30, 2020 vest thirty (30) days after the date of such grant. Granted pursuant to the Issuer's 2020 Employee Incentive Plan /s/ Doug Croxall 2021-01-29