SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
Musunuri Shankar

(Last) (First) (Middle)
C/O OCUGEN, INC.
5 GREAT VALLEY PARKWAY, SUITE 160

(Street)
MALVERN, PA 19355

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/27/2019
3. Issuer Name and Ticker or Trading Symbol
Ocugen, Inc. [ OCGN ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 1,375,299 I By KVM Holdings, LLC(1)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Warrants (Right to Buy) 09/27/2019 09/14/2027 Common Stock 7,191(2) 7.56 D
Warrants (Right to Buy) 09/27/2019 12/08/2026 Common Stock 405(2) 5.05 I By KVM Holdings, LLC(1)
Stock Option (right to buy) 09/27/2019 08/26/2025 Common Stock 86,292(3) 1.88 D
Explanation of Responses:
1. The Reporting Person is a member and officer of KVM Holdings, LLC and has voting and investment power power over the shares held by KVM Holdings, LLC.
2. 100% of the Warrants became exercisable immediately.
3. 100% of the Stock Options became exercisable immediately.
Remarks:
/s/ Shankar Musunuri by Kelly Beck, his attorney-in-fact 12/13/2019
** 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 5 (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.
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