0000950170-24-035555.txt : 20240322 0000950170-24-035555.hdr.sgml : 20240322 20240322184939 ACCESSION NUMBER: 0000950170-24-035555 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: Gurfein Blake CENTRAL INDEX KEY: 0001891888 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41052 FILM NUMBER: 24776594 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 0001891888 Gurfein Blake 25821 INDUSTRIAL BLVD., SUITE 100 HAYWARD CA 94545 false true false false Chief Scientific Officer false Employee Stock Option (Right to Buy) 1.34 2024-03-12 4 A false 10000 0 A 2034-03-11 Common Stock 10000 10000 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, attorney-in-fact 2024-03-22