0001062993-24-013605.txt : 20240709 0001062993-24-013605.hdr.sgml : 20240709 20240709204031 ACCESSION NUMBER: 0001062993-24-013605 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: Dinu Raluca CENTRAL INDEX KEY: 0001430575 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40839 FILM NUMBER: 241108499 MAIL ADDRESS: STREET 1: C/O GIGCAPITAL2, INC. STREET 2: 2479 E. BAYSHORE RD., SUITE 200 CITY: PALO ALTO STATE: CA ZIP: 94303 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 0001430575 Dinu Raluca C/O QT IMAGING HOLDINGS, INC. 3 HAMILTON LANDING SUITE 160 NOVATO CA 94949 1 1 0 0 Chief Executive Officer 0 Common Stock 26592 D Employee Stock Option (right to buy) 0.748 2024-07-03 4 A 0 550000 0 A 2034-07-03 Common Stock 550000 550000 D Stock Option (right to buy) 0.748 2024-07-03 4 A 0 40000 0 A 2034-07-03 Common Stock 40000 40000 D 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/ Dr. Raluca Dinu 2024-07-09