0001213900-22-017226.txt : 20220401 0001213900-22-017226.hdr.sgml : 20220401 20220401104525 ACCESSION NUMBER: 0001213900-22-017226 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211210 FILED AS OF DATE: 20220401 DATE AS OF CHANGE: 20220401 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MacKenzie Donald S CENTRAL INDEX KEY: 0001890325 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-56216 FILM NUMBER: 22796408 MAIL ADDRESS: STREET 1: 5251 FISHER ISLAND DRIVE CITY: MIAMI BEACH STATE: FL ZIP: 33109 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BRAIN SCIENTIFIC INC. CENTRAL INDEX KEY: 0001662382 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 810876714 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 6700 PROFESSIONAL PARKWAY CITY: LAKEWOOD RANCH STATE: FL ZIP: 34240 BUSINESS PHONE: (646) 388-3788 MAIL ADDRESS: STREET 1: 6700 PROFESSIONAL PARKWAY CITY: LAKEWOOD RANCH STATE: FL ZIP: 34240 FORMER COMPANY: FORMER CONFORMED NAME: All Soft Gels Inc DATE OF NAME CHANGE: 20151229 4 1 ownership.xml X0306 4 2021-12-10 0 0001662382 BRAIN SCIENTIFIC INC. BRSF 0001890325 MacKenzie Donald S 5251 FISHER ISLAND DRIVE MIAMI BEACH FL 33109 1 0 0 0 Options to Purchase Shares of Common Stock 0.29 2022-02-03 4 A 0 362069 0 A 2031-12-11 Common Stock 362069 362069 D The options were initially issued to Mr. MacKenzie pursuant to a stock option agreement, dated December 10, 2021, whereby Mr. MacKenzie was issued 61,140 options to purchase shares of common stock of the Issuer with an exercise price of $0.21. On February 3, 2022, the Issuer and Mr. MacKenzie entered into an amended stock option agreement (the "Amendment") whereby (i) the number of options issued to Mr. MacKenzie was amended to 362,069, and the exercise price was amended to $0.29. Pursuant to the Amendment, the options shall vest and become exercisable pursuant to the following schedule: 46,623 options vested and became exercisable on December 31, 2021, 89,277 options vested and became exercisable on March 31, 2022; 90,269 options shall become exercisable on June 30, 2022, 91,261 options shall become exercisable on September 30,2022; and 44,639 options shall become exercisable on December 31, 2022. /s/ Donald MacKenzie 2022-04-01