0001213900-23-000975.txt : 20230105 0001213900-23-000975.hdr.sgml : 20230105 20230105061704 ACCESSION NUMBER: 0001213900-23-000975 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20221230 FILED AS OF DATE: 20230105 DATE AS OF CHANGE: 20230105 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LOSH J MICHAEL CENTRAL INDEX KEY: 0001199190 FISCAL YEAR END: 1130 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39553 FILM NUMBER: 23509669 MAIL ADDRESS: STREET 1: H.B. FULLER COMPANY STREET 2: P.O. BOX 64683 CITY: ST. PAUL STATE: MN ZIP: 55164-0683 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Amesite Inc. CENTRAL INDEX KEY: 0001807166 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 823431717 STATE OF INCORPORATION: DE FISCAL YEAR END: 0630 BUSINESS ADDRESS: STREET 1: 205 EAST WASHINGTON STREET STREET 2: SUITE B CITY: ANN ARBOR STATE: MI ZIP: 48104 BUSINESS PHONE: (650) 516-7633 MAIL ADDRESS: STREET 1: 205 EAST WASHINGTON STREET STREET 2: SUITE B CITY: ANN ARBOR STATE: MI ZIP: 48104 FORMER COMPANY: FORMER CONFORMED NAME: Amesite Operating Co DATE OF NAME CHANGE: 20200318 4 1 ownership.xml X0306 4 2022-12-30 0 0001807166 Amesite Inc. AMST 0001199190 LOSH J MICHAEL C/O AMESITE INC. 607 SHELBY STREET, SUITE 700 PMB 214 DETROIT MI 48226 1 0 0 0 Restricted Stock Units 2022-12-30 4 A 0 82857 0 A Common Stock 82857 199984 I J. Michael Losh Irrevocable Qualified Annuity Trust #7 Each restricted stock unit ("RSU") represents a contingent right to receive one share of AMST common stock and/or the cash equivalent of such share. The reported securities were issued as "deferred stock units" in lieu of cash compensation earned for services as a director, and the number of deferred stock units received was calculated based on the closing share price on the last day of the quarter. The deferred stock units or cash equivalent will be issued to the reporting person upon completion of service as a member of the board of directors or, if earlier, a change in control. Exhibit 24.1 Power of Attorney /s/ Sherrie Farrell, Attorney-in-Fact 2023-01-05 EX-24.1 2 ea171248ex24-1_amesiteinc.htm POWER OF ATTORNEY

Exhibit 24.1

 

POWER OF ATTORNEY

 

The undersigned, as a Section 16 reporting person of Amesite Inc. (the “Company”), hereby constitutes and appoints each of Ann Marie Sastry, Ph.D. and Sherrie Farrell as the undersigned’s true and lawful attorneys-in-fact to:

 

  1. complete and execute Forms 3, 4 and 5 and other forms and all amendments thereto as such attorney-in-fact shall in their discretion determine to be required or advisable pursuant to Section 16 of the Securities Exchange Act of 1934, as amended, and the rules and regulations promulgated thereunder, or any successor laws and regulations, as a consequence of the undersigned’s ownership, acquisition or disposition of securities of the Company;

 

  2. do all acts necessary in order to file such forms with the Securities and Exchange Commission, any securities exchange or national association, the Company and such other person or agency as the attorney-in-fact shall deem appropriate; and
     
  3. take any other action of any type whatsoever in connection with the foregoing that, in the opinion of such attorneys-in-fact, may be of benefit to, in the best interests of, or legally required by the undersigned, it being understood that the documents executed by such attorneys-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in such attorney-in-fact’s discretion.

 

The undersigned hereby ratifies and confirms all that said attorneys-in-fact and agents shall do or cause to be done by virtue hereof.  The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned’s responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended.

 

This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 and 5 with respect to the undersigned’s holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the Company and the foregoing attorneys-in-fact.

 

IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of January 4, 2023.

 

  Signature:      /s/ J. Michael Losh
  Print Name: J. Michael Losh