Initial Statement of Beneficial Ownership (3)
September 09 2021 - 4:11PM
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
*
Hill Arik |
2. Date of Event Requiring Statement (MM/DD/YYYY)
8/30/2021
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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 Information Officer / |
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(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) |
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) | 8/30/2022 (2) | 8/30/2031 | Ontrak, Inc. Common Stock | 100000 | $12.07 | D | |
| Explanation of Responses: |
| (1) | Mr. Hill was appointed as the Company's Chief Information Officer on August 30, 2021. These options were granted to Mr. Hill for his services as the Chief Information Officer of the Company. |
| (2) | 25% of these options shall vest one year from the date of grant and the remaining options shall vest equally over the next 36 months. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Hill Arik
2120 COLORADO AVE., SUITE 230
SANTA MONICA, CA 90404 |
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| Chief Information Officer |
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Signatures
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| /s/ Arik Hill | | 9/9/2021 |
| **Signature of Reporting Person | Date |
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