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