SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Vaynberg Boris

(Last) (First) (Middle)
C/O VENUS CONCEPT INC.
235 YORKLAND BLVD., SUITE 900

(Street)
TORONTO A6 M2J 4Y8

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Venus Concept Inc. [ VERO ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Technology Officer
3. Date of Earliest Transaction (Month/Day/Year)
11/07/2019
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 11/07/2019 A 5,333 A $3.75(1) 5,333 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Options (right to buy) $1.35 11/07/2019 A 45,271 (2) 12/31/2023 Common Stock 45,271 (3) 45,271 D
Employee Stock Options (right to buy) $3.6 11/07/2019 A 47,001 (2) 06/01/2024 Common Stock 47,001 (4) 47,001 D
Employee Stock Options (right to buy) $5.25 11/07/2019 A 11,534 (2) 04/30/2025 Common Stock 11,534 (5) 11,534 D
Employee Stock Options (right to buy) $7.95 11/07/2019 A 11,534 (6) 08/08/2028 Common Sock 11,534 (7) 11,534 D
Warrants (right to buy) $6 11/07/2019 A 5,333(1) 05/07/2020 11/07/2024 Common Stock 2,666.5(1) (1) 5,333(1) D
Explanation of Responses:
1. These securities were purchased from the Issuer at a purchase price of $3.75 per unit, consisting of one share of Common Stock and a warrant exercisable for 0.5 shares of Common Stock, with two warrants exercisable for one share of Common Stock at an exercise price of $6.00 per share.
2. As of the Transaction Date, these options to acquire Common Stock of the Issuer are fully vested and exercisable.
3. Received, in connection with the merger of a wholly-owned subsidiary of Restoration Robotics, Inc. with and into Venus Concept Ltd. (the "Merger"), in exchange for an employee stock option to acquire 78,500 Venus Concept Ltd. ordinary shares with an original exercise price of $0.75 per share.
4. Received, in connection with the Merger, in exchange for an employee stock option to acquire 81,500 Venus Concept Ltd. ordinary shares with an original exercise price of $2.00 per share.
5. Received, in connection with the Merger, in exchange for an employee stock option to acquire 20,000 Venus Concept Ltd. ordinary shares with an original exercise price of $3.00 per share.
6. As of the Transaction Date, 3,362 of these options to acquire Common Stock of the Issuer are fully vested and exercisable. The remaining balance of 8,172 options vest ratably and become exercisable each month from November 8, 2019 to August 8, 2022.
7. Received, in connection with the Merger, in exchange for an employee stock option to acquire 20,000 Venus Concept Ltd. ordinary shares with an original exercise price of $4.57 per share.
Remarks:
/s/ Domenic Di Sisto, attorney-in-fact 11/07/2019
** 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 4 (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.
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