0001540354-23-000012.txt : 20231113 0001540354-23-000012.hdr.sgml : 20231113 20231113173057 ACCESSION NUMBER: 0001540354-23-000012 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20231109 FILED AS OF DATE: 20231113 DATE AS OF CHANGE: 20231113 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Rosa David A CENTRAL INDEX KEY: 0001540354 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40439 FILM NUMBER: 231400273 MAIL ADDRESS: STREET 1: 10901 RED CIRCLE DRIVE STREET 2: SUITE 150 CITY: MINNETONKA STATE: MN ZIP: 55343 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: NEUROONE MEDICAL TECHNOLOGIES Corp CENTRAL INDEX KEY: 0001500198 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 270863354 STATE OF INCORPORATION: DE FISCAL YEAR END: 0930 BUSINESS ADDRESS: STREET 1: 7599 ANAGRAM DR CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 BUSINESS PHONE: (952) 426-1383 MAIL ADDRESS: STREET 1: 7599 ANAGRAM DR CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 FORMER COMPANY: FORMER CONFORMED NAME: Original Source Entertainment, Inc. DATE OF NAME CHANGE: 20100830 4 1 primary_doc.xml PRIMARY DOCUMENT X0508 4 2023-11-09 0 0001500198 NEUROONE MEDICAL TECHNOLOGIES Corp NMTC 0001540354 Rosa David A 7599 ANAGRAM DRIVE EDEN PRAIRIE MN 55344 1 1 0 0 CEO and President 0 Option to Purchase Common Stock 1.25 2023-11-09 4 A 0 526303 0 A 2033-11-08 Common Stock 526303 526303 D 25% will vest on November 9, 2024, and the remaining 75% will vest in 36 equal monthly installments on the last day of each month following November 9, 2024. /s/ Stephanie Swan, by Power of Attorney 2023-11-13