Statement of Changes in Beneficial Ownership (4)
29 Oktober 2020 - 9:32PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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
*
Green Philip D |
2. Issuer Name and Ticker or Trading Symbol
Livongo Health, Inc.
[
LVGO
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O LIVONGO HEALTH, INC., 150 WEST EVELYN AVENUE, SUITE 150 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
10/27/2020 |
(Street)
MOUNTAIN VIEW, CA 94041
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 10/26/2020 | | G |
V
| 7274 | D | $0 | 39395 | I | See footnote (1) |
Common Stock | 10/26/2020 | | G |
V
| 7274 | D | $0 | 39395 | I | See footnote (2) |
Common Stock | 10/26/2020 | | G |
V
| 7274 | D | $0 | 39394 | I | See footnote (3) |
Common Stock | 10/26/2020 | | G |
V
| 21822 | A | $0 | 23790 | D | |
Common Stock | 10/27/2020 | | M | | 16666 | A | $1.38 | 56061 | I | See footnote (1) |
Common Stock | 10/27/2020 | | M | | 16667 | A | $1.38 | 56062 | I | See footnote (2) |
Common Stock | 10/27/2020 | | M | | 16667 | A | $1.38 | 56061 | I | See footnote (3) |
Common Stock | 10/27/2020 | | M | | 11805 | A | $1.88 | 67866 | I | See footnote (1) |
Common Stock | 10/27/2020 | | M | | 11805 | A | $1.88 | 67867 | I | See footnote (2) |
Common Stock | 10/27/2020 | | M | | 11805 | A | $1.88 | 67866 | I | See footnote (3) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Option (right to buy) | $1.38 | 10/27/2020 | | M | | | 16666 | (4) | 11/15/2026 | Common Stock | 16666.0 | $0 | 0 | I | See footnote (1) |
Stock Option (right to buy) | $1.38 | 10/27/2020 | | M | | | 16667 | (4) | 11/15/2026 | Common Stock | 16667.0 | $0 | 0 | I | See footnote (2) |
Stock Option (right to buy) | $1.38 | 10/27/2020 | | M | | | 16667 | (4) | 11/15/2026 | Common Stock | 16667.0 | $0 | 0 | I | See footnote (3) |
Stock Option (right to buy) | $1.88 | 10/27/2020 | | M | | | 11805 | (5) | 12/3/2027 | Common Stock | 11805.0 | $0 | 4862 | I | See footnote (1) |
Stock Option (right to buy) | $1.88 | 10/27/2020 | | M | | | 11805 | (5) | 12/3/2027 | Common Stock | 11805.0 | $0 | 4862 | I | See footnote (2) |
Stock Option (right to buy) | $1.88 | 10/27/2020 | | M | | | 11805 | (5) | 12/3/2027 | Common Stock | 11805.0 | $0 | 4861 | I | See footnote (3) |
Explanation of Responses: |
(1) | The shares are held of record by The Philip D. Green 2012 Children's Trust FBO Joshua D. Green for which the reporting person's spouse serves as trustee. |
(2) | The shares are held of record by The Philip D. Green 2012 Children's Trust FBO Justin J. Green for which the reporting person's spouse serves as trustee. |
(3) | The shares are held of record by The Philip D. Green 2012 Children's Trust FBO Alexandra E. Green for which the reporting person's spouse serves as trustee. |
(4) | Shares subject to the option are fully vested and immediately exercisable. |
(5) | One-fourth of the shares subject to the option vested on December 4, 2018 and 1/48 of the shares vest monthly thereafter. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Green Philip D C/O LIVONGO HEALTH, INC. 150 WEST EVELYN AVENUE, SUITE 150 MOUNTAIN VIEW, CA 94041 | X |
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Signatures
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/s/ Jonathan Dorfman, by power of attorney | | 10/29/2020 |
**Signature of Reporting Person | Date |
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