Harari Eliyahou Et al - 01 Jul 2025 Form 3 Insider Report for CapsoVision, Inc (CV)

Role
10%+ Owner
Signature
/s/ Peter Bergman, Attorney-in-Fact for Eliyahou Harari
Issuer symbol
CV
Transactions as of
01 Jul 2025
Net transactions value
$0
Form type
3
Filing time
02 Jul 2025, 19:57:31 UTC
Next filing
08 Jul 2025
SEC
View on sec.gov

Reporting Owners (1)

Name Relationship Address Signature Signature date CIK
HARARI ELIYAHOU ET AL 10%+ Owner 225 CHARCOT, SAN JOSE /s/ Peter Bergman, Attorney-in-Fact for Eliyahou Harari 01 Jul 2025 0001009165

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
holding CV Common Stock 280,000 01 Jul 2025 Direct F1

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 D-1 Preferred Stock 01 Jul 2025 Common Stock 222,222 By trust. F2, F3
holding CV Series D-2 Preferred Stock 01 Jul 2025 Common Stock 934,588 By trust. F2, F3
holding CV Series E Preferred Stock 01 Jul 2025 Common Stock 434,782 By trust. F2, F3
holding CV Series F-1 Preferred Stock 01 Jul 2025 Common Stock 434,783 By trust. F2, F3
holding CV Series F-2 Preferred Stock 01 Jul 2025 Common Stock 2,000,000 By trust. F2, F3
holding CV Series G Preferred Stock 01 Jul 2025 Common Stock 740,741 By trust. F2, F3
holding CV Series G-1 Preferred Stock 01 Jul 2025 Common Stock 1,206,898 By trust. F2, F3
holding CV Series H Preferred Stock 01 Jul 2025 Common Stock 4,638,377 By trust. F2, F3
holding CV Series H Preferred Stock 01 Jul 2025 Common Stock 1,724,139 By trust. F2, F4
holding CV Series H Preferred Stock 01 Jul 2025 Common Stock 1,724,139 By trust. F2, F5
* 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 of the initial public offering of the Issuer.
F2 Each share of Series D-1 preferred stock, Series D-2 preferred stock, Series E preferred stock, Series F-1 preferred stock, Series F-2 preferred stock, Series G preferred stock, Series G-1 preferred stock and Series H preferred stock (the Preferred Stock) is convertible on a one-to-one basis into shares of common stock at the election of the holder and has no expiration date. The Preferred Stock will automatically convert into the underlying shares of common stock upon the closing of the initial public offering of the Issuer. 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 of the initial public offering of the Issuer.
F3 The securities are held by the Harari Family Trust, for which the Reporting Person, together with his wife, are trustees.
F4 The securities are held by Harari 2010 Children Remainder Trust - MHG, for which the Reporting Person, together with his wife, are trustees.
F5 The securities are held by Harari 2010 Children Remainder Trust - DAH, for which the Reporting Person, together with his wife, are trustees.