0001213900-21-004951.txt : 20210128
0001213900-21-004951.hdr.sgml : 20210128
20210128164510
ACCESSION NUMBER: 0001213900-21-004951
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210128
FILED AS OF DATE: 20210128
DATE AS OF CHANGE: 20210128
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Koch Timothy
CENTRAL INDEX KEY: 0001837958
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39924
FILM NUMBER: 21565742
MAIL ADDRESS:
STREET 1: 1110 NE CIRCLE BLVD.
CITY: CORVALLIS
STATE: OR
ZIP: 97330
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: 0331
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
3
1
ownership.xml
OWNERSHIP DOCUMENT
X0206
3
2021-01-28
0
0001761696
Crown Electrokinetics Corp.
CRKN
0001837958
Koch Timothy
C/O CROWN ELECTROKINETICS CORP.
1110 NE CIRCLE BLVD.
CORVALLIS
OR
97330
0
1
0
0
Chief Technology Officer
Common Stock
400000
D
Call Option
0.15
2028-02-28
Common Stock
243333
D
Call Option
1.20
2029-01-17
Common Stock
50000
D
Call Option
2.25
2030-04-13
Common Stock
320000
D
Call Option
3.60
2030-12-30
Common Stock
597015
D
Consists of 400,000 shares of restricted stock, all of which has vested.
Issued pursuant to the Issuer's 2016 Equity Incentive Plan.
Options to purchase shares of the Issuer's Common Stock have vested and are currently exercisable.
Options to purchase shares of the Issuer's Common Stock granted on December 30, 2020 vest thirty (30) days after the date of such grant.
Granted pursuant to the Issuer's 2020 Employee Incentive Plan.
/s/ Timothy Koch
2021-01-28