SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Tammenoms Bakker Juliet

(Last) (First) (Middle)
C/O RXSIGHT, INC.
100 COLUMBIA

(Street)
ALISO VIEJO CA 92656

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
RxSight, Inc. [ RXST ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
08/03/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 08/03/2021 P 12,500 A $16 18,359 D
Common Stock 08/03/2021 C 1,863,613 A $0.00(1)(2) 1,863,613 I See footnote(3)
Common Stock 08/03/2021 P 125,000 A $16 1,988,613 I See footnote(3)
Common Stock 08/03/2021 P 500,000 A $16 500,000 I See footnote(4)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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 (Month/Day/Year) 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: 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
Series G Preferred Stock (1) 08/03/2021 C 1,613,423 (1) (1) Common Stock 1,613,423 $0.00(1) 0 I See footnote(3)
Series H Preferred Stock (2) 08/03/2021 C 242,013 (2) (2) Common Stock 242,013 $0.00(2) 0 I See footnote(3)
Warrant (right to buy) $12.4 08/03/2021 M(5) 36,302 02/24/2017 (5) Series H Preferred Stock 36,302 $0.00(2) 0 I See footnote(3)
Series H Preferred Stock (2) 08/03/2021 M(5) 36,302 (2) (2) Common Stock 36,302 $0.00(2) 36,302 I See footnote(3)
Series H Preferred Stock (2) 08/03/2021 F(5) 28,125 (2) (2) Common Stock 28,125 $0.00(2) 8,177 I See footnote(3)
Series H Preferred Stock (2) 08/03/2021 C 8,177 (2) (2) Common Stock 8,177 $0.00(2) 0 I See footnote(3)
Explanation of Responses:
1. All shares of the Series G Preferred Stock, par value $0.001 per share, of the Issuer automatically converted on a one-for-one basis to shares of the Issuer's common stock, par value $0.001 per share ("Common Stock") immediately prior to the closing of the Issuer's initial public offering of its Common Stock.
2. All shares of the Series H Preferred Stock, par value $0.001 per share, of the Issuer automatically converted on a one-for-one basis to shares of the Issuer's common stock, par value $0.001 per share ("Common Stock") immediately prior to the closing of the Issuer's initial public offering of its Common Stock.
3. Shares and warrant are held by Longitude Venture Partners II, L.P. ("LVP II"). Longitude Capital Partners II, LLC ("LCP II") is the general partner of LVP II and may be deemed to have voting and investment power over the securities held by LVP II. The Reporting Person, a member of the Issuer's board of directors, is a managing member of LCP II and may be deemed to share voting and investment power over the securities held by LVP II. LVP II, LCP II and the Reporting Person disclaim beneficial ownership of such shares except to the extent of their respective pecuniary interests therein.
4. Shares are held by Longitude Prime Fund, L.P. ("LPF"). Longitude Prime Partners, LLC ("LPP") is the general partner of LPF and may be deemed to have voting and investment power over the securities held by LPF. The Reporting Person, a member of the Issuer's board of directors, is a managing member of LPP and may be deemed to share voting and investment power over the securities held by LPF. LPF, LPP and the Reporting Person disclaim beneficial ownership of such shares except to the extent of their respective pecuniary interests therein.
5. The warrant was automatically net exercised for Series H Preferred Stock immediately prior to the closing of the Issuer's initial public offering of its Common Stock.
Remarks:
/s/ Shelley Thunen, as Attorney-in-Fact 08/05/2021
** 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).
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