0001104659-22-072042.txt : 20220616 0001104659-22-072042.hdr.sgml : 20220616 20220616194442 ACCESSION NUMBER: 0001104659-22-072042 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220614 FILED AS OF DATE: 20220616 DATE AS OF CHANGE: 20220616 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Zikria Dean CENTRAL INDEX KEY: 0001877611 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41052 FILM NUMBER: 221022009 MAIL ADDRESS: STREET 1: C/O INTUITY MEDICAL, INC. STREET 2: 3500 WEST WARREN AVENUE CITY: FREMONT STATE: CA ZIP: 94538 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Tivic Health Systems, Inc. CENTRAL INDEX KEY: 0001787740 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 814016391 STATE OF INCORPORATION: CA 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 tm2218712-1_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2022-06-14 0 0001787740 Tivic Health Systems, Inc. TIVC 0001877611 Zikria Dean 25821 INDUSTRIAL BLVD., SUITE 100 HAYWARD CA 94545 1 0 0 0 Employee Stock Option (Right to Buy) 1.75 2022-06-14 4 A 0 40000 0 A 2032-06-13 Common Stock 40000 40000 D The option vests as follows: (i) 50% one year from the grant date, and (ii) the remaining 50% in equal monthly installments over the next 24 months. /s/ Jennifer Ernst, attorney-in-fact 2022-06-16