Harari Eliyahou Et al - 03 Jul 2025 Form 4/A - Amendment 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
03 Jul 2025
Net transactions value
$0
Form type
4/A - Amendment
Filing time
08 Jul 2025, 21:01:41 UTC
Date Of Original Report
08 Jul 2025
Previous filing
02 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 08 Jul 2025 0001009165

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
transaction CV Common Stock Conversion of derivative security +3,186,904 3,186,904 03 Jul 2025 By trust. F1, F2
transaction CV Common Stock Conversion of derivative security +517,759 517,759 03 Jul 2025 By trust. F1, F3
transaction CV Common Stock Conversion of derivative security +517,759 517,759 03 Jul 2025 By trust. F1, F4

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
transaction CV Series D-1 Preferred Stock Conversion of derivative security $0 -222,222 -100% $0.000000 0 03 Jul 2025 Common Stock 66,733 By trust. F1, F2
transaction CV Series D-2 Preferred Stock Conversion of derivative security $0 -934,588 -100% $0.000000 0 03 Jul 2025 Common Stock 280,657 By trust. F1, F2
transaction CV Series E Preferred Stock Conversion of derivative security $0 -434,782 -100% $0.000000 0 03 Jul 2025 Common Stock 130,565 By trust. F1, F2
transaction CV Series F-1 Preferred Stock Conversion of derivative security $0 -434,783 -100% $0.000000 0 03 Jul 2025 Common Stock 130,565 By trust. F1, F2
transaction CV Series F-2 Preferred Stock Conversion of derivative security $0 -2,000,000 -100% $0.000000 0 03 Jul 2025 Common Stock 600,601 By trust. F1, F2
transaction CV Series G Preferred Stock Conversion of derivative security $0 -740,741 -100% $0.000000 0 03 Jul 2025 Common Stock 222,445 By trust. F1, F2
transaction CV Series G-1 Preferred Stock Conversion of derivative security $0 -1,206,898 -100% $0.000000 0 03 Jul 2025 Common Stock 362,432 By trust. F1, F2
transaction CV Series H Preferred Stock Conversion of derivative security $0 -4,638,377 -100% $0.000000 0 03 Jul 2025 Common Stock 1,392,906 By trust. F1, F2
transaction CV Series H Preferred Stock Conversion of derivative security $0 -1,724,139 -100% $0.000000 0 03 Jul 2025 Common Stock 517,759 By trust. F1, F3
transaction CV Series H Preferred Stock Conversion of derivative security $0 -1,724,139 -100% $0.000000 0 03 Jul 2025 Common Stock 517,759 By trust. F1, F4
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Harari Eliyahou Et al is no longer subject to Section 16 filing requirements. Form 4 or Form 5 obligations may continue.

Explanation of Responses:

Id Content
F1 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 automatically converted into approximately 0.3003 shares of common stock of the Issuer upon the closing of the initial public offering of the Issuer. The number of shares reported herein gives effect to a 1-for-3.33 reverse stock split of the common stock of the Issuer effected by the Issuer on July 2, 2025 in connection with its initial public offering.
F2 The securities are held by the Harari Family Trust, for which the Reporting Person, together with his wife, are trustees.
F3 The securities are held by Harari 2010 Children Remainder Trust - MHG, for which the Reporting Person, together with his wife, are trustees.
F4 The securities are held by Harari 2010 Children Remainder Trust - DAH, for which the Reporting Person, together with his wife, are trustees.

Remarks:

Amended to: - correct address of record - check box re no longer subject to Section 16