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