Rebecca Ann Petersen - 18 Aug 2025 Form 4 Insider Report for CapsoVision, Inc (CV)

Role
Director of Clinical Affairs
Signature
/s/ Tai Vivatvaraphol, Attorney-in-Fact for Rebecca Petersen
Issuer symbol
CV
Transactions as of
18 Aug 2025
Net transactions value
+$9,097
Form type
4
Filing time
22 Aug 2025, 20:44:52 UTC
Previous filing
01 Jul 2025
SEC
View on sec.gov

Reporting Owners (1)

Name Relationship Address Signature Signature date CIK
Petersen Rebecca Ann Director of Clinical Affairs C/O CAPSOVISION, INC., 18805 COX AVENUE, SUITE 250, SARATOGA /s/ Tai Vivatvaraphol, Attorney-in-Fact for Rebecca Petersen 22 Aug 2025 0002075458

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
transaction CV Common Stock Options Exercise $9,097 +24,834 $0.3663 24,834 18 Aug 2025 Direct

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 Stock Option (right to buy) Options Exercise $0 -7,507 -100% $0.000000 0 18 Aug 2025 Common Stock 7,507 $0.3663 Direct F1, F2, F3
transaction CV Stock Option (right to buy) Options Exercise $0 -17,327 -82% $0.000000 3,694 18 Aug 2025 Common Stock 17,327 $0.3663 Direct F1, F3, F4
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 These options were previously reported at exercise price of $0.11 per share. The exercise price reported herein gives effect to a 1-for-3.33 reverse stock split effected by the Issuer on July 2, 2025 in connection with its initial public offering.
F2 The option was granted on October 28, 2021 and is fully vested and exercisable as of the transaction date.
F3 There options were previously reported as covering 25,000 and 70,000 shares, respectively. The number of shares reported herein gives effect to a 1-for-3.33 reverse stock split effected by the Issuer on July 2, 2025 in connection with its initial public offering.
F4 The option was granted on March 23, 2022 and is partially vested and exercisable as of the transaction date.

Remarks:

The Form 4 is being filed late due to an inadvertent administrative error.