0001213900-21-065896.txt : 20211217 0001213900-21-065896.hdr.sgml : 20211217 20211217121556 ACCESSION NUMBER: 0001213900-21-065896 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210929 FILED AS OF DATE: 20211217 DATE AS OF CHANGE: 20211217 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CROXALL DOUGLAS B CENTRAL INDEX KEY: 0001331155 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39924 FILM NUMBER: 211500428 MAIL ADDRESS: STREET 1: 2331 MILL ROAD SUITE 100 CITY: ALEXANDRIA STATE: VA ZIP: 22314 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Crown Electrokinetics Corp. CENTRAL INDEX KEY: 0001761696 STANDARD INDUSTRIAL CLASSIFICATION: ELECTRONIC COMPONENTS, NEC [3679] IRS NUMBER: 475423944 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1110 NE CIRCLE BLVD CITY: CORVALLIS STATE: OR ZIP: 97330 BUSINESS PHONE: 800-674-3612 MAIL ADDRESS: STREET 1: 1110 NE CIRCLE BLVD CITY: CORVALLIS STATE: OR ZIP: 97330 4 1 ownership.xml X0306 4 2021-09-29 0 0001761696 Crown Electrokinetics Corp. CRKN 0001331155 CROXALL DOUGLAS B C/O CROWN ELECTROKINETICS CORP. 11601 WILSHIRE BLVD., SUITE 2240 LOS ANGELES CA 90025 1 1 1 0 Chief Executive Officer Restricted Stock Award 2021-09-29 4 A 0 238095 0 A 238095 D Restricted Stock Unit 2021-09-29 4 A 0 1061905 A Common Stock 1061905 1061905 D Issued as reimbursement for certain fees and expenses previously advanced to third parties by the Reporting Person. Awarded in connection with the listing of the Issuer's common stock on The Nasdaq Stock Market pursuant to the Issuer's 2020 Employee Incentive Plan in satisfaction of the Reporting Person's entitlement to such award as set forth in the Reporting Person's employment agreement with the Issuer. Each restricted stock unit represents a contingent right to receive one share of the Issuer's Common Stock. Certain of these restricted stock units were issued as reimbursement for securities previously held by the Reporting Person that were cancelled by the Issuer. The restricted stock units vest on January 26, 2022, subject to the Reporting Person remaining in continuous service with the Issuer through such date. In the event of a change in control of the Issuer, all then-unvested restricted stock units will vest as of the date of such change in control; if the Reporting Person terminates service with the Issuer as a result of his death, disability or a termination by the Issuer without cause, 100% of the unvested restricted stock units will vest as of the date of such termination. Share of unrestricted Common Stock of the Issuer will be issued with respect to vested restricted stock units on the earliest to occur of (1) January 26, 2022; (2) the Reporting Person's separation from service; (3) a change in control; or (4) the Reporting Person's death. Not applicable. /s/ Douglas B. Croxall 2021-12-17