FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 07/27/2022 |
3. Issuer Name and Ticker or Trading Symbol
MAIA Biotechnology, Inc. [ MAIA ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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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 | 783,121 | D | |
Common Stock | 200,000 | I | See Footnote(1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: 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 | ||||
Stock Options | (2) | 09/30/2028 | Common Stock | 700,000 | $1.8 | D | |
Stock Options | (3) | 09/30/2028 | Common Stock | 105,000 | $1.8 | D | |
Stock Options | (4) | 04/01/2030 | Common Stock | 115,500 | $1.8 | D | |
Stock Options | (5) | 04/01/2030 | Common Stock | 54,000 | $1.8 | D | |
Stock Options | (6) | 11/02/2030 | Common Stock | 405,789 | $1.8 | D | |
Stock Options | (6) | 11/02/2030 | Common Stock | 100,000 | $1.8 | I | See Footnote(7) |
Stock Options | (6) | 11/02/2030 | Common Stock | 100,000 | $1.8 | I | See Footnote(8) |
Stock Options | (9) | 12/31/2030 | Common Stock | 23,695 | $1.8 | D | |
Stock Options | (10) | 04/15/2031 | Common Stock | 190,356 | $1.83 | D | |
Stock Options | (11) | 03/31/2031 | Common Stock | 23,078 | $1.83 | D | |
Stock Options | (12) | 04/15/2031 | Common Stock | 219,550 | $1.83 | D | |
Stock Options | (13) | 04/15/2031 | Common Stock | 100,000 | $1.83 | D | |
Stock Options | (14) | 06/30/2031 | Common Stock | 7,529 | $1.83 | D | |
Stock Options | (15) | 04/22/2031 | Common Stock | 10,159 | $1.83 | I | See Footnote(1) |
Stock Options | (16) | 11/16/2031 | Common Stock | 18,000 | $1.83 | I | See Footnote(1) |
Warrants | (17) | (17) | Common Stock | 1,811 | $6 | D |
Explanation of Responses: |
1. These securities are beneficially owned by Mr. Vitoc's spouse. The reporting person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
2. Represents an option to purchase shares of Common Stock granted pursuant to the 2018 Stock Option Plan. These options vested in 48 equal monthly installments, with a 1 year cliff, beginning on October 1, 2018. |
3. Represents an option to purchase shares of Common Stock granted pursuant to the 2018 Stock Option Plan. 35,000 of these options vested on October 1, 2018, 28,000 of the options vested on January 1, 2019, 21,000 of the options vested on April 1, 2019, 14,000 of the options vested on July 1, 2019, and 7,000 of the options vested on October 1, 2019. |
4. Represents an option to purchase shares of Common Stock granted pursuant to the 2018 Stock Option Plan. These options fully vested on April 30, 2020. |
5. Represents an option to purchase shares of Common Stock granted pursuant to the 2018 Stock Option Plan. These options fully vested on January 1, 2021. |
6. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options are fully vested on November 3, 2020. |
7. These securities are held by MAIA Laetitia Cristian Vitoc 2022 MAIA Irrevocable Trust, for the benefit of Mr. Vitoc's child, for which Mr. Vitoc's spouse serves as trustee. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. |
8. These securities are held by Leia Violeta Ioana Vitoc 2022 MAIA Irrevocable Trust, for the benefit of Mr. Vitoc's child, for which Mr. Vitoc's spouse serves as trustee. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. |
9. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options vested in ninety equal daily installments beginning on January 1, 2021. |
10. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options fully vested on May 20, 2021. |
11. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options vested in 90 equal daily installments beginning on April 1, 2021. |
12. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options fully vested on May 20, 2021. |
13. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options vest in 36 equal monthly installments beginning on January 1, 2021. |
14. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options fully vested on July 1, 2021. |
15. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options vested in seven equal monthly instalments beginning on May 31, 2021. |
16. Represents an option to purchase shares of Common Stock granted pursuant to the 2020 Equity Incentive Plan. These options vested in 12 equal monthly instalments beginning on December 16, 2021. |
17. Each Warrant became exercisable on the date of issuance of April 03, 2020, and expires on the earliest to occur of: (a) March 2, 2028; or (b) immediately prior to the closing of any change of control of the issuer. |
Remarks: |
/s/ Vlad Vitoc | 07/27/2022 | |
** 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 5 (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 Number. |