0001213900-23-012241.txt : 20230215 0001213900-23-012241.hdr.sgml : 20230215 20230215201047 ACCESSION NUMBER: 0001213900-23-012241 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230214 FILED AS OF DATE: 20230215 DATE AS OF CHANGE: 20230215 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kuzemchik Vladislav CENTRAL INDEX KEY: 0001965805 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41626 FILM NUMBER: 23636888 MAIL ADDRESS: STREET 1: 180 MAIDEN LANE STREET 2: 11TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10005 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: NYIAX, INC. CENTRAL INDEX KEY: 0001679379 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROCESSING & DATA PREPARATION [7374] IRS NUMBER: 460547534 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 244 5TH AVENUE STREET 2: SUITE 2669 CITY: NEW YORK STATE: NY ZIP: 10001 BUSINESS PHONE: 4156027855 MAIL ADDRESS: STREET 1: 244 5TH AVENUE STREET 2: SUITE 2669 CITY: NEW YORK STATE: NY ZIP: 10001 3 1 ownership.xml OWNERSHIP DOCUMENT X0206 3 2023-02-14 0 0001679379 NYIAX, INC. NYX 0001965805 Kuzemchik Vladislav C/O NYIAX, INC. 180 MAIDEN LANE, 11TH FLOOR NEW YORK NY 10005 0 1 0 0 Chief Architect of Technology Stock Options 3.30 2028-06-18 Common Stock 25000 D Stock Options 3.30 2030-04-01 Common Stock 5000 D Stock Options 3.30 2030-09-28 Common Stock 20000 D Stock Options 4.30 2030-09-28 Common Stock 5000 D Stock Options 5.50 2032-11-01 Common Stock 25000 D Stock Options 5.50 2032-04-01 Common Stock 1500 D On June 18, 2018, the Reporting Person was issued stock options to purchase 25,000 shares of common stock of the Issuer with 8,334 options vesting immediately as of October 18, 2018 and 16,666 options vesting in 1/24 equal increments per month from October 18, 2018. These options are fully vested and exercisable. On April 1, 2020, the Reporting Person was issued stock options to purchase 5,000 shares of common stock of the Issuer with all 5,000 options vesting as of June 1, 2020. On October 1, 2020, the Reporting Person was issued stock options to purchase 20,000 shares of common stock of the Issuer with 1,666 options vesting immediately as of October 1, 2020 and 18,333 options vesting in 1,666 options per month increments thereafter. On October 1, 2020, the Reporting Person was issued stock options to purchase 5,000 shares of common stock of the Issuer with 416.66 options vesting immediately as of October 1, 2020 and approximately 4,583 options vesting in 416.66 options per month increments thereafter. On April 27, 2022, the Reporting Person was issued stock options to purchase 25,000 shares of common stock of the Issuer vesting (at a rate of 1/48 of the total award of 25,000 options) over a four-year period with twelve months vesting on November 11, 2022 and vesting continuing monthly thereafter, until the stock option award is fully vested. The stock options vest (at a rate of 1/48 of the total award of 25,000 options) over a four-year period with twelve months vesting on November 11, 2022 and vesting continuing monthly thereafter, until fully vested. On April 27, 2022, the Reporting Person was issued stock options to purchase 1,500 shares of common stock of the Issuer vesting (at a rate of 1/48 of the total award of 1,500 options) over a four-year period with twelve months vesting on January 1, 2023 and vesting continuing monthly thereafter, until the stock option award is fully vested. The stock options vest (at a rate of 1/48 of the total award of 1,500 options) over a four-year period with twelve months vesting on January 1, 2023 and vesting continuing monthly thereafter, until fully vested. /s/ Vladislav Kuzemchik 2023-02-15