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*
Podbelski Adam Andrew

(Last) (First) (Middle)
C/O VIEWRAY, INC.
1099 18TH STREET, SUITE 3000

(Street)
DENVER CO 80202

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/15/2023
3. Issuer Name and Ticker or Trading Symbol
ViewRay, Inc. [ VRAY ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
SVP, Customer Services
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 186,957(4) 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 Option (right to buy) (1) 09/15/2028 Common Stock 100,000 $9.18 D
Stock Option (right to buy) (2) 03/01/2029 Common Stock 24,000 $8.47 D
Performance Units (3) (3) Common Stock 70,327 $0 D
Explanation of Responses:
1. 25% of the shares subject to the option shall vest and become exercisable on the first anniversary after September 15, 2018 (the "Grant Date") and 1/36th of the shares shall vest and become exercisable each month after the first anniversary, September 15, 2019, such that 100% of the shares subject to the option will be vested on the fourth anniversary of the Grant Date, subject to the reporting person remaining a service provider through each vesting date.
2. 1/48th of the shares subject to the option shall vest and become exercisable on each month after March 1, 2019 (the "Grant Date"), such that 100% of the shares subject to the option will be vested on the fourth anniversary of the Grant Date, subject to the reporting person remaining a service provider through each such vesting date.
3. These performance share awards were issued at a 100% target and have a 3-year vest period and will vest in all or in part upon achievement of performance metrics. Any awards that have not been vested and released at the end of the 3-year period will be canceled.
4. Represents 177,892 shares of Restricted Stock Units (RSUs) and 9,065 shares purchased as part of the Employee Stock Purchase Plan (ESPP). The RSUs vest in three equal annual installments beginning on the first anniversary of the grant date. Mr. Podbelski has been granted the following: 10/24/2019 52,500 shares, 1/15/2020 22,500 shares, 3/2/2020 39,007 shares, 3/1/2021 24,141 shares, 3/1/2022 18,115 shares, 3/15/2022 41,322, and 3/1/2023 40,322 shares. The ESPP requires a one-year holding period after the purchase of the shares. Mr. Podbelski purchased the following shares as part of the ESPP: 1/4/2021 1,415 shares, 7/1/2021 648 shares, 1/3/2022 2,573 shares, 7/1/2022 1,429 shares, and 1/3/2022 3,000 shares. As of 7/15/2023, 154,552 shares are sellable.
Remarks:
/s/ Sanket Shah, Attorney-in-fact 07/26/2023
** 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.