0000950170-24-096480.txt : 20240813 0000950170-24-096480.hdr.sgml : 20240813 20240813174846 ACCESSION NUMBER: 0000950170-24-096480 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240809 FILED AS OF DATE: 20240813 DATE AS OF CHANGE: 20240813 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bolton Sheryle CENTRAL INDEX KEY: 0001418947 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41052 FILM NUMBER: 241203315 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] ORGANIZATION NAME: 08 Industrial Applications and Services IRS NUMBER: 814016391 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 47685 LAKEVIEW BLVD CITY: FREMONT STATE: CA ZIP: 94538 BUSINESS PHONE: (888)276-6888 MAIL ADDRESS: STREET 1: 47685 LAKEVIEW BLVD CITY: FREMONT STATE: CA ZIP: 94538 4 1 ownership.xml 4 X0508 4 2024-08-09 0001787740 Tivic Health Systems, Inc. TIVC 0001418947 Bolton Sheryle 47685 LAKEVIEW BLVD. FREMONT CA 94538 true false false false false Employee Stock Option (Right to Buy) 0.41 2024-08-09 4 A false 3000 0 A 2034-08-08 Common Stock 3000 3000 D The option vests in a series of twelve (12) successive equal monthly installments, rounded downward to the nearest whole share, from the grant date, such that 100% of the option will be vested upon the first anniversary of the grant date. /s/ Jennifer Ernst, attorney-in-fact 2024-08-13