0000899243-21-048904.txt : 20211217
0000899243-21-048904.hdr.sgml : 20211217
20211217204319
ACCESSION NUMBER: 0000899243-21-048904
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211215
FILED AS OF DATE: 20211217
DATE AS OF CHANGE: 20211217
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Appelbaum Kevin J
CENTRAL INDEX KEY: 0001547557
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39864
FILM NUMBER: 211503411
MAIL ADDRESS:
STREET 1: 4160 DUBLIN BLVD., SUITE 200
CITY: DUBLIN
STATE: CA
ZIP: 94568
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kevin Appelbaum, or his successor(s), as Trustee of the Kevin Appelbaum Revocable Trust under Revocable Trust Declaration dated 5/16/2020, as amended
CENTRAL INDEX KEY: 0001890904
STATE OF INCORPORATION: OR
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39864
FILM NUMBER: 211503410
BUSINESS ADDRESS:
STREET 1: 548 MARKET STREET, #49404
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
BUSINESS PHONE: 415.887.2311
MAIL ADDRESS:
STREET 1: 548 MARKET STREET, #49404
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Better Therapeutics, Inc.
CENTRAL INDEX KEY: 0001832415
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HEALTH SERVICES [8000]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1028
BUSINESS ADDRESS:
STREET 1: 311 WEST 43RD STREET, 12TH FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10036
BUSINESS PHONE: 646-493-6558
MAIL ADDRESS:
STREET 1: 311 WEST 43RD STREET, 12TH FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10036
FORMER COMPANY:
FORMER CONFORMED NAME: Mountain Crest Acquisition Corp II
DATE OF NAME CHANGE: 20201116
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-12-15
0
0001832415
Better Therapeutics, Inc.
BTTX
0001547557
Appelbaum Kevin J
C/O BETTER THERAPEUTICS, INC.
548 MARKET STREET, #49404
SAN FRANCISCO
CA
94104
1
1
1
0
Chief Executive Officer
0001890904
Kevin Appelbaum, or his successor(s), as Trustee of the Kevin Appelbaum Revocable Trust under Revocable Trust Declaration dated 5/16/2020, as amended
C/O BETTER THERAPEUTICS, INC.
548 MARKET STREET, #49404
SAN FRANCISCO
CA
94104
0
0
1
0
Common Stock
2021-12-15
4
P
0
750
4.7065
A
2750
D
Common Stock
2406719
I
By Trust
These shares are owned directly by Kevin Appelbaum, or his successor(s), as Trustee of the Kevin Appelbaum Revocable Trust under Revocable Trust Declaration dated May 16, 2020, as amended (the "Trust"), and indirectly by Mr. Appelbaum as trustee of the Trust. Mr. Appelbaum is an officer, director and ten percent owner of Issuer.
/s/ Mark Heinen, Attorney-in-Fact for Kevin J. Appelbaum
2021-12-17
/s/ Mark Heinen, Attorney-in-Fact for Kevin Appelbaum, or his successor(s), as Trustee of the Kevin Appelbaum Revocable Trust under Revocable Trust Declaration dated May 16, 2020, as amended
2021-12-17