0001213900-23-025464.txt : 20230331 0001213900-23-025464.hdr.sgml : 20230331 20230331161023 ACCESSION NUMBER: 0001213900-23-025464 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200112 FILED AS OF DATE: 20230331 DATE AS OF CHANGE: 20230331 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CROXALL DOUGLAS B CENTRAL INDEX KEY: 0001331155 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39924 FILM NUMBER: 23787691 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: 1231 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 4 1 ownership.xml OWNERSHIP DOCUMENT X0407 4 2020-01-12 0 0001761696 Crown Electrokinetics Corp. CRKN 0001331155 CROXALL DOUGLAS B 1110 NE CIRCLE BLVD CORVALLIS OR 97330 1 1 1 0 Chief Executive Officer 0 Common Stock 2020-01-12 2020-01-12 4 D 0 238095 0 D 2829448 I See Footnote Common Stock 2021-11-10 2021-11-10 4 S 0 1000000 0.90 D 1829448 I See Footnote Restricted Stock Units 2022-09-23 2022-09-23 4 A 0 150000 0 A Common Stock 150000 150000 I See Footnote Options to Purchase Common Stock 0.34 2022-09-23 2022-09-23 4 A 0 150000 0 A 2032-09-23 Common Stock 150000 3365672 I See Footnote Reflects the forfeiture of certain incentive compensation for no consideration. Share amount reflects 3-for-1 reverse stock split effected January 25, 2021. Held through Croxall Family Revocable Trust dated February 20, 2004. Each restricted stock unit represents a contingent right to receive one share of the Issuer's Common Stock. Subject to the Reporting Person remaining in continuous service with the Issuer through each applicable vesting date, 4,166 of the restricted stock units will vest monthly for a period of 36 months, beginning September 23, 2022. /s/ Douglas Croxall 2023-03-31