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*
McKune John

(Last) (First) (Middle)
C/O PULMONX CORPORATION
700 CHESAPEAKE DRIVE

(Street)
REDWOOD CITY CA 94063

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/10/2023
3. Issuer Name and Ticker or Trading Symbol
Pulmonx Corp [ LUNG ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Interim CFO
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 41,356(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
Employee Stock Option (right to buy) (2) 08/28/2030 Common Stock 30,050 $2.2 D
Employee Stock Option (right to buy) (3) 05/31/2031 Common Stock 13,300 $43.4 D
Employee Stock Option (right to buy) (4) 02/29/2032 Common Stock 21,500 $26.56 D
Employee Stock Option (right to buy) (5) 02/28/2033 Common Stock 17,500 $11.48 D
Explanation of Responses:
1. Includes 2,582, 6,063 and 22,400 Restricted Stock Units payable solely in common stock of the Issuer that vest over four years in equal quarterly installments beginning on June 1, 2021, March 1, 2022 and March 1, 2023, respectively.
2. The option vests over a four-year period, with 1/4th of the shares subject to the option vesting on the one year anniversary of the vesting commencement date of August 24, 2020, and 1/36th of the remaining shares subject to the option vesting each month thereafter, subject to the Reporting Person's continuous service through each such vesting date.
3. The shares subject to the option vest in 48 equal monthly installments beginning on June 1, 2021, subject to the Reporting Person's continuous service through each such vesting date.
4. The shares subject to the option vest in 48 equal monthly installments beginning on March 1, 2022, subject to the Reporting Person's continuous service through each such vesting date.
5. The shares subject to the option vest in 48 equal monthly installments beginning on March 1, 2023, subject to the Reporting Person's continuous service through each such vesting date.
Remarks:
/s/John McKune 10/19/2023
** 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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.