0001209191-21-067470.txt : 20211202 0001209191-21-067470.hdr.sgml : 20211202 20211202135317 ACCESSION NUMBER: 0001209191-21-067470 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211201 FILED AS OF DATE: 20211202 DATE AS OF CHANGE: 20211202 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lewis Scott Richard CENTRAL INDEX KEY: 0001757430 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-32929 FILM NUMBER: 211465912 MAIL ADDRESS: STREET 1: 2016 BECKETT DRIVE CITY: EL DORADO HILLS STATE: CA ZIP: 95762 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MoSys, Inc. CENTRAL INDEX KEY: 0000890394 STANDARD INDUSTRIAL CLASSIFICATION: SEMICONDUCTORS & RELATED DEVICES [3674] IRS NUMBER: 770291941 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2309 BERING DRIVE CITY: SAN JOSE STATE: CA ZIP: 95131 BUSINESS PHONE: 408 418 7500 MAIL ADDRESS: STREET 1: 2309 BERING DRIVE CITY: SAN JOSE STATE: CA ZIP: 95131 FORMER COMPANY: FORMER CONFORMED NAME: MONOLITHIC SYSTEM TECHNOLOGY INC DATE OF NAME CHANGE: 19960613 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-12-01 0 0000890394 MoSys, Inc. MOSY 0001757430 Lewis Scott Richard 2309 BERING DR SAN JOSE CA 95131 1 0 0 0 Restricted Stock Units 2021-12-01 4 A 0 2000 A 5000 D Restricted Stock Unit ("RSU") award granted on December 1, 2021. Each RSU represents a contingent right to receive one share of the Company's common stock once vested. The entire award vests and becomes non-forfeitable on December 1, 2022, or, if earlier, the next annual meeting of stockholders following December 1, 2021, subject to reporting person's continuous service with the Company. In accordance with Instruction 4 to this Form, Column 5 reports only the total beneficial ownership of the "class" of derivative security reported in Column 1. /s/ James Sullivan by power of attorney 2021-12-02