SEC Form 3
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*
Kovelman Harry

(Last) (First) (Middle)
137 PORTLAND ST.
4TH FLOOR

(Street)
BOSTON MA 02114

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
03/18/2021
3. Issuer Name and Ticker or Trading Symbol
MYOMO, INC. [ MYO ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Medical Officer
5. 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 Beneficially Owned
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 18,263(1) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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) 11/01/2030 Common Stock 5,000(3) $4.47 D
Explanation of Responses:
1. Included in this number is 18,000 Restricted Stock Units ("RSU's) granted under the Issuer's 2018 Stock Option Incentive Plan on November 2, 2020 ("Grant Date"), each representing a contingent right to receive one share of the Issuer's common stock. The RSU's vest 25% on the first anniversary of the Grant Date and in 36 monthly installments thereafter.
2. Stock Options are subject to a vesting schedule and are not exercisable on a specific date
3. Represents 5,000 stock options granted under the Issuer's 2018 Stock Option Incentive Plan on the Grant Date, The stock options vest 25% on the first anniversary of the Grant Date and in 36 monthly installments thereafter.
Remarks:
/s/ David Henry, Attorney-in-fact 03/25/2021
** 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 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.
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