Chen Lung Tsai - 01 Jul 2025 Form 3 Insider Report for CapsoVision, Inc (CV)

Role
Director
Signature
/s/ Tai Vivatvaraphol, Attorney-in-Fact for Chen Lung Tsai
Issuer symbol
CV
Transactions as of
01 Jul 2025
Net transactions value
$0
Form type
3
Filing time
01 Jul 2025, 21:25:37 UTC
Next filing
06 Feb 2026
SEC
View on sec.gov

Reporting Owners (1)

Name Relationship Address Signature Signature date CIK
Tsai Chen Lung Director C/O CAPSOVISION, INC., 18805 COX AVENUE, SUITE 250, SARATOGA /s/ Tai Vivatvaraphol, Attorney-in-Fact for Chen Lung Tsai 01 Jul 2025 0001307275

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
holding CV Common Stock 80,000 01 Jul 2025 By trust. F1, F3

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Underlying Class Amount Exercise Price Ownership Footnotes
holding CV Series B Preferred Stock 01 Jul 2025 Common Stock 71,429 By trust. F2, F3
holding CV Series D-1 Preferred Stock 01 Jul 2025 Common Stock 55,555 By trust. F2, F3
holding CV Series E Preferred Stock 01 Jul 2025 Common Stock 86,956 By trust. F2, F3
holding CV Series H Preferred Stock 01 Jul 2025 Common Stock 90,534 By trust. F2, F3
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 Does not reflect a one-for-3.33 reverse stock split, to be effective immediately prior to the closing to the Issuer's initial public offering.
F2 Each share of Series B preferred stock, Series D-1 preferred stock, Series E preferred stock and Series H preferred stock (the "Preferred Stock") is convertible on a one-to-one basis into the underlying shares of common stock at the holder's election and has no expiration date. The Preferred Stock will automatically convert into common stock upon the closing of the Issuer's initial public offering. The number of underlying shares of common stock reported in Column 3 does not reflect a one-for-3.33 reverse stock split, to be effective immediately prior to the closing to the Issuer's initial public offering.
F3 The securities are held by The Tsai Family Trust, for which the Reporting Person, together with his wife, are trustees.

Remarks:

Exhibit 24 - Power of Attorney