0000899243-23-015784.txt : 20230616
0000899243-23-015784.hdr.sgml : 20230616
20230616173007
ACCESSION NUMBER: 0000899243-23-015784
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230614
FILED AS OF DATE: 20230616
DATE AS OF CHANGE: 20230616
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Bolton Sheryle
CENTRAL INDEX KEY: 0001418947
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41052
FILM NUMBER: 231022429
MAIL ADDRESS:
STREET 1: 55 ALMADEN BLVD
CITY: SAN JOSE
STATE: CA
ZIP: 95113
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Tivic Health Systems, Inc.
CENTRAL INDEX KEY: 0001787740
STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845]
IRS NUMBER: 814016391
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 25821 INDUSTRIAL BLVD., SUITE 100
CITY: HAYWARD
STATE: CA
ZIP: 94545
BUSINESS PHONE: (888)276-6888
MAIL ADDRESS:
STREET 1: 25821 INDUSTRIAL BLVD., SUITE 100
CITY: HAYWARD
STATE: CA
ZIP: 94545
4
1
doc4.xml
FORM 4 SUBMISSION
X0407
4
2023-06-14
0
0001787740
Tivic Health Systems, Inc.
TIVC
0001418947
Bolton Sheryle
25821 INDUSTRIAL BLVD.,
SUITE 100
HAYWARD
CA
94545
1
0
0
0
0
Employee Stock Option (Right to Buy)
0.09
2023-06-14
4
A
0
25000
0.00
A
2033-06-13
Common Stock
25000
25000
D
The option vests as follows: (i) 50% on the first anniversary of the grant date, (ii) 25% on the second anniversary of the grant date, and (iii) 25% on the third anniversary of the grant date.
/s/ Jennifer Ernst, attorney-in-
2023-06-16