0001683168-21-003082.txt : 20210723 0001683168-21-003082.hdr.sgml : 20210723 20210723162748 ACCESSION NUMBER: 0001683168-21-003082 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210709 FILED AS OF DATE: 20210723 DATE AS OF CHANGE: 20210723 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: IWAKI YUICHI CENTRAL INDEX KEY: 0001263965 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-33185 FILM NUMBER: 211111173 MAIL ADDRESS: STREET 1: C/O MEDICINOVA, INC. STREET 2: 4275 EXECUTIVE SQUARE, SUITE 650 CITY: LA JOLLA STATE: CA ZIP: 92037 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MEDICINOVA INC CENTRAL INDEX KEY: 0001226616 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 330927979 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 4275 EXECUTIVE SQUARE STREET 2: SUITE 300 CITY: LA JOLLA STATE: CA ZIP: 92037 BUSINESS PHONE: 858-373-1500 MAIL ADDRESS: STREET 1: 4275 EXECUTIVE SQUARE STREET 2: SUITE 300 CITY: LA JOLLA STATE: CA ZIP: 92037 4 1 ownership.xml X0306 4 2021-07-09 0 0001226616 MEDICINOVA INC MNOV 0001263965 IWAKI YUICHI C/O MEDICINOVA, INC. 4275 EXECUTIVE SQUARE, SUITE 300 LA JOLLA CA 92037 1 1 0 0 President and CEO Common Stock 2021-07-09 4 M 0 39583 2.54 A 966933 D Common Stock 125000 I See Footnote Employee Stock option (Right to Buy) 2.54 2021-07-09 4 M 0 39583 0 D 2021-07-12 Common Stock 39583 0 D The reported securities are held by the Iwaki Family Limited Partnership. The reporting person is the general partner of the partnership that owns the reported securities. The reporting person disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein. The option vested over a period of 4 years in equal monthly installments from the 7/13/2011 date of grant and is now fully vested. /s/ Yuichi Iwaki 2021-07-23