SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Bush Richard

(Last) (First) (Middle)
C/O NYIAX, INC.
180 MAIDEN LANE, 11TH FLOOR

(Street)
NEW YORK NY 10005

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/14/2023
3. Issuer Name and Ticker or Trading Symbol
NYIAX, INC. [ NYX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief of Staff
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Options(1) (2) 10/02/2026 Common Stock 85,000 $3.3 D
Stock Options(3) (2) 01/01/2028 Common Stock 100,000 $5 D
Explanation of Responses:
1. On October 2, 2016 the Reporting Person was issued incentive stock options to purchase 85,000 shares of common stock of the Issuer with 28,334 options vesting immediately as of October 2, 2017 and 56,666 options vesting in 1/24 equal increments per month starting from October 2, 2017.
2. These options are fully vested and exercisable.
3. On January 1, 2018 the Reporting Person was issued incentive stock options to purchase 100,000 shares of common stock of the Issuer with 333,33 options vesting on January 1, 2019 and 66,667 options vesting at a rate of 2,778 options per month thereafter.
/s/ Richard Bush 02/15/2023
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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