Initial Statement of Beneficial Ownership (3)
August 20 2021 - 4:50PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
*
Park James J |
2. Date of Event Requiring Statement (MM/DD/YYYY)
8/10/2021
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3. Issuer Name and Ticker or Trading Symbol
Ontrak, Inc. [OTRK]
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(Last)
(First)
(Middle)
2120 COLORADO AVE., SUITE 230 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) Chief Accounting Officer / Principal Accounting Officer |
(Street)
SANTA MONICA, CA 90404
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 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 Beneficially Owned
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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) |
Common Stock (1) | 3200 | D | |
Common Stock (1) | 273.20 (2) | I | by 401(k) Plan |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
Option (right to buy) (1)(3) | 9/16/2020 (4) | 12/2/2029 | Ontrak, Inc. Common Stock | 35000 | $15.55 | D | |
Option (right to buy) (1)(3) | 9/16/2020 (5) | 2/12/2030 | Ontrak, Inc. Common Stock | 65000 | $16.01 | D | |
Restricted Stock Unit (1) | (7) | (8) | Ontrak, Inc. Common Stock | 2000 | (6) | D | |
Explanation of Responses: |
(1) | On August 10, 2021, Mr. Park was appointed as the Principal Accounting Officer of the Company. |
(2) | As of August 16, 2021, Mr. Park has acquired 273.2 shares of the Company's common stock under the Company's 401(k) plan. |
(3) | On September 16, 2019, Mr. Park joined the Company as Chief Accounting Officer. These options were granted to Mr. Park for his services as Chief Accounting Officer of the Company. |
(4) | Stock options were granted on December 2, 2019, with 25% vested on September 16, 2020 and the remaining vesting equally over the next 36 months. |
(5) | Stock options were granted on February 12, 2020, with 25% vested on September 16, 2020 and the remaining vesting equally over the next 36 months. |
(6) | Each restricted stock unit ("RSU") represents the right to receive one share of common stock upon vesting. |
(7) | On June 14, 2021, Mr. Park was granted 2,000 RSU's, subject to Mr. Park's continued employment with the Company. The RSU's vest over five years as follows: 40% shall vest on the second anniversary of the grant date and 20% shall vest on the third, fourth and fifth anniversaries of the grant date subject to Mr. Park's continued employment. |
(8) | No expiration date for this type of award |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Park James J 2120 COLORADO AVE., SUITE 230 SANTA MONICA, CA 90404 |
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| Chief Accounting Officer | Principal Accounting Officer |
Signatures
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/s/ James Park | | 8/20/2021 |
**Signature of Reporting Person | Date |
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