Statement of Changes in Beneficial Ownership (4)
23 6월 2023 - 6:07AM
Edgar (US Regulatory)
FORM 4
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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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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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
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FORST EDWARD C |
2. Issuer Name and Ticker or Trading Symbol
Local Bounti Corporation/DE
[
LOCL
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O LOCAL BOUNTI CORPORATION, 400 W. MAIN ST. |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/20/2023 |
(Street)
HAMILTON, MT 59840 |
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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(City)
(State)
(Zip)
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Rule 10b5-1(c) Transaction Indication
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Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan that is intended to
satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 6/20/2023 | | A | | 21237 (1) | A | $0.00 | 77406 (2) | D | |
Common Stock | | | | | | | | 55911 (2) | I | By Forst GST LLC |
Common Stock | | | | | | | | 36499 (2) | I | By Wellfor LLC |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
Warrants to purchase Common Stock | $149.50 (3) | | | | | | | 12/19/2021 | 11/19/2026 | Common Stock | 38076 (3) | | 495000 | D | |
Warrants to purchase Common Stock | $149.50 (3) | | | | | | | 12/19/2021 | 11/19/2026 | Common Stock | 39304 (3) | | 510952 | I | By Forst GST LLC |
Warrants to purchase Common Stock | $149.50 (3) | | | | | | | 12/3/2021 | 11/19/2026 | Common Stock | 1685 (3) | | 21912 | D | |
Explanation of Responses: |
(1) | The restricted stock units will vest on the earlier of (1) the day before Local Bounti Corporation's (the "Issuer") next annual stockholders' meeting or (2) June 20, 2024, subject to the Reporting Person's continued service. |
(2) | Effective on June 15, 2023, the Issuer effected a 1 to 13 reverse stock split of its common stock (the "Reverse Stock Split"). The amount of securities reported on this Form 4 has been adjusted to reflect the Reverse Stock Split. |
(3) | The exercise price and amount of common stock underlying the warrants after exercise take into account the Reverse Stock Split. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
FORST EDWARD C C/O LOCAL BOUNTI CORPORATION 400 W. MAIN ST. HAMILTON, MT 59840 | X |
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Signatures
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/s/ Kathleen Valiasek, as Attorney-in-Fact for Edward C. Forst | | 6/22/2023 |
**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 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. |
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 control number. |
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