0001213900-21-004942.txt : 20210128
0001213900-21-004942.hdr.sgml : 20210128
20210128164020
ACCESSION NUMBER: 0001213900-21-004942
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210128
FILED AS OF DATE: 20210128
DATE AS OF CHANGE: 20210128
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kovalik Edward
CENTRAL INDEX KEY: 0001606277
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39924
FILM NUMBER: 21565685
MAIL ADDRESS:
STREET 1: 1 GRAND ARMY PLAZA, 11 GG
CITY: BROOKLYN
STATE: NY
ZIP: 11238
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Crown Electrokinetics Corp.
CENTRAL INDEX KEY: 0001761696
STANDARD INDUSTRIAL CLASSIFICATION: ELECTRONIC COMPONENTS, NEC [3679]
IRS NUMBER: 475423944
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0331
BUSINESS ADDRESS:
STREET 1: 1110 NE CIRCLE BLVD
CITY: CORVALLIS
STATE: OR
ZIP: 97330
BUSINESS PHONE: 800-674-3612
MAIL ADDRESS:
STREET 1: 1110 NE CIRCLE BLVD
CITY: CORVALLIS
STATE: OR
ZIP: 97330
3
1
ownership.xml
OWNERSHIP DOCUMENT
X0206
3
2021-01-28
0
0001761696
Crown Electrokinetics Corp.
CRKN
0001606277
Kovalik Edward
2926 PEMBERTON DRIVE
HOUSTON
TX
77005
1
0
0
0
Common Stock
0
D
Call Option
4.50
2030-12-01
Common Stock
33333
D
Issued pursuant to the Issuer's 2016 Equity Incentive Plan.
Options to purchase 33,333 shares of the Issuer's Common Stock, all of which have vested.
/s/ Edward Kovalik
2021-01-28