0000950170-24-035553.txt : 20240322
0000950170-24-035553.hdr.sgml : 20240322
20240322184756
ACCESSION NUMBER: 0000950170-24-035553
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20240312
FILED AS OF DATE: 20240322
DATE AS OF CHANGE: 20240322
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Ernst Jennifer
CENTRAL INDEX KEY: 0001889915
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41052
FILM NUMBER: 24776589
MAIL ADDRESS:
STREET 1: 750 MENLO AVENUE
STREET 2: SUITE 200
CITY: MENLO PARK
STATE: CA
ZIP: 94025
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Tivic Health Systems, Inc.
CENTRAL INDEX KEY: 0001787740
STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845]
ORGANIZATION NAME: 08 Industrial Applications and Services
IRS NUMBER: 814016391
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 25821 INDUSTRIAL BLVD., SUITE 100
CITY: HAYWARD
STATE: CA
ZIP: 94545
BUSINESS PHONE: (888)276-6888
MAIL ADDRESS:
STREET 1: 25821 INDUSTRIAL BLVD., SUITE 100
CITY: HAYWARD
STATE: CA
ZIP: 94545
4
1
ownership.xml
4
X0508
4
2024-03-12
0001787740
Tivic Health Systems, Inc.
TIVC
0001889915
Ernst Jennifer
25821 INDUSTRIAL BLVD., SUITE 100
HAYWARD
CA
94545
true
true
false
false
Chief Executive Officer
false
Employee Stock Option (Right to Buy)
1.34
2024-03-12
4
A
false
32000
0
A
2034-03-11
Common Stock
32000
32000
D
The option vests as follows: (i) 50% on the first anniversary of the grant date and (ii) the remaining 50% in 12 equal monthly installments over the 12 months thereafter.
/s/ Jennifer Ernst
2024-03-22