Statement of Changes in Beneficial Ownership (4)
November 04 2022 - 6:53PM
Edgar (US Regulatory)
FORM 4
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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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
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Shanbhag Santosh |
2. Issuer Name and Ticker or Trading Symbol
Akili, Inc.
[
AKLI
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Chief Financial Officer |
(Last)
(First)
(Middle)
C/O AKILI, INC., 125 BROAD STREET, FIFTH FLOOR |
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/2/2022 |
(Street)
BOSTON, MA 02110
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 11/2/2022 | | A | | 19795 | A | (1) | 19795 | D | |
Common Stock | 11/2/2022 | | A | | 284650 | A | (2) | 304445 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Option (Right to Buy) | $2.30 | 11/2/2022 | | A | | 80381 | | (3) | 11/2/2032 | Common Stock | 80381 | $0.00 | 80381 | D | |
Explanation of Responses: |
(1) | Represents a grant of restricted stock units ("RSUs") under the Akili, Inc. 2022 Stock Option and Incentive Plan (the "Plan"). Each RSU represents the contingent right to receive one share of the Issuer's common stock upon vesting and settlement. 16.67% of the RSUs underlying this grant shall vest on May 2, 2023, with an additional 16.67% vesting at the end of each six (6) month period thereafter, subject to the reporting person's continued service on each such vesting date. |
(2) | Represents a grant of RSUs under the Plan. Each RSU represents the contingent right to receive one share of the Issuer's common stock upon vesting and settlement. The RSUs underlying this grant shall vest upon the Issuer's common stock achieving certain specified prices per share, subject to the reporting person's continued service at such time. |
(3) | 16.67% of the shares underlying this option shall vest and become exercisable on May 2, 2023, with an additional 16.67% vesting at the end of each six (6) month period thereafter, subject to the reporting person's continued service on each such vesting date. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Shanbhag Santosh C/O AKILI, INC. 125 BROAD STREET, FIFTH FLOOR BOSTON, MA 02110 |
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| Chief Financial Officer |
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Signatures
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/s/ Jacqueline Studer, attorney-in-fact | | 11/4/2022 |
**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 4(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. |
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
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