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