0001062993-24-013607.txt : 20240709 0001062993-24-013607.hdr.sgml : 20240709 20240709204152 ACCESSION NUMBER: 0001062993-24-013607 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: Katz Avi S CENTRAL INDEX KEY: 0001451693 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40839 FILM NUMBER: 241108503 MAIL ADDRESS: STREET 1: C/O GIGCAPITAL, INC. STREET 2: 3000 EL CAMINO REAL, BLDG 4, SUITE 232 CITY: PALO ALTO STATE: CA ZIP: 94306 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GigAcquisitions5, LLC CENTRAL INDEX KEY: 0001844511 ORGANIZATION NAME: STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40839 FILM NUMBER: 241108502 BUSINESS ADDRESS: STREET 1: 1731 EMBARCADERO ROAD SUITE 200 CITY: PALO ALTO STATE: CA ZIP: 94303 BUSINESS PHONE: 6502767040 MAIL ADDRESS: STREET 1: 1731 EMBARCADERO ROAD 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 0001451693 Katz Avi S C/O QT IMAGING HOLDINGS, INC. 3 HAMILTON LANDING, SUITE 160 NOVATO CA 94949 1 1 1 0 Chairman 0001844511 GigAcquisitions5, LLC C/O QT IMAGING HOLDINGS, INC. 3 HAMILTON LANDING, SUITE 160 NOVATO CA 94949 0 0 1 0 0 Common Stock 2024-07-05 4 J 0 105773 0 D 5735000 I By GigAcquisitions5, LLC Common Stock 26593 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 Private Warrants 2.3 2024-07-05 4 J 0 105773 0 D 2024-04-03 2029-03-04 Common Stock 105773 0 I By GigAcquisitions5, LLC Distribution of shares of Common Stock to direct and indirect members of GigAcqusitions5, LLC (the "Sponsor"). The total reported shares is a result of the deduction of the number of disposed shares of Common Stock from 5,840,773 shares of Common Stock as previously reported in Form 4 filed by the Reporting Person on July 1, 2024. The Common Stock is held directly by Sponsor. The shares held by the Sponsor are beneficially owned by Dr. Katz. Dr. Katz is also the Manager of the Sponsor, who has sole voting and dispositive power over the shares held by the Sponsor. 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 Dr. Katz's continued service to the Issuer, through each vesting date. Distribution of Private Warrants to direct and indirect members of the Sponsor. /s/ Dr. Avi S. Katz 2024-07-09 /s/ Dr. Avi S. Katz, Managing Member 2024-07-09