0001683168-22-001214.txt : 20220222 0001683168-22-001214.hdr.sgml : 20220222 20220222200111 ACCESSION NUMBER: 0001683168-22-001214 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220218 FILED AS OF DATE: 20220222 DATE AS OF CHANGE: 20220222 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KING STEVEN W CENTRAL INDEX KEY: 0001244106 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-22182 FILM NUMBER: 22660289 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Mosaic ImmunoEngineering Inc. CENTRAL INDEX KEY: 0000836564 STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836] IRS NUMBER: 841070278 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 19881 BROOKHURST STREET, C-245 CITY: HUNTINGTON BEACH STATE: CA ZIP: 92646 BUSINESS PHONE: 657-208-0890 MAIL ADDRESS: STREET 1: 19881 BROOKHURST STREET, C-245 CITY: HUNTINGTON BEACH STATE: CA ZIP: 92646 FORMER COMPANY: FORMER CONFORMED NAME: PATRIOT SCIENTIFIC CORP DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: PATRIOT FINANCIAL CORP DATE OF NAME CHANGE: 19920521 4 1 ownership.xml X0306 4 2022-02-18 0 0000836564 Mosaic ImmunoEngineering Inc. CPMV 0001244106 KING STEVEN W 1537 SOUTH NOVATO BLVD., #5 NOVATO CA 94947 1 1 1 0 President and CEO Convertible Note 2022-02-18 4 J 0 20000 20000 A See footnotes 20000 D The Convertible Notes were issued on February 18, 2022 in exchange of $20,000 in proceeds to the Company; have no stated maturity date or expiration date; bear interest at a simple rate equal to eight percent (8.0%) per annum until converted; and automatically convert into the same equity securities offered in the Qualified Financing (see footnote 2 and 3) or at the option of the holder into the same equity securities offered in a Smaller Financing (see footnote 2 and 3). Upon a Qualified Financing or Smaller Financing (see footnote 3), the conversion price shall be equal to the lower of (i) the product equal to 80% times the lowest per unit purchase price of the equity securities issued for cash in the Qualified Financing or Smaller Financing (representing a 20% discount), or (ii) $1.00. A Qualified Financing represents a single transaction or series or transactions whereby the Company receives aggregate gross proceeds of at least $5 million from the sale of equity securities following the issuance date of the Convertible Note (excluding proceeds from the issuance of any future Convertible Notes). A Smaller Financing represents any sale of equity securities whereby the aggregate gross proceeds are less than $5 million (excluding proceeds from the issuance of any future Convertible Notes). /s/ Paul Lytle, as attorney-in-fact for Steven King 2022-02-22