Statement of Changes in Beneficial Ownership (4)
17 März 2023 - 09:15PM
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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
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OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response... 0.5 |
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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 * Dudum
Andrew |
2. Issuer Name and Ticker or Trading
Symbol Hims & Hers Health, Inc. [ HIMS ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director __X__
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
Chief Executive Officer |
(Last)
(First)
(Middle)
2269 CHESTNUT STREET, #523 |
3. Date of Earliest Transaction (MM/DD/YYYY)
3/15/2023
|
(Street)
SAN FRANCISCO, CA 94123
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
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 Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
Amount |
(A) or (D) |
Price |
Class A Common Stock |
3/15/2023 |
|
M |
|
76454 |
A |
(1) |
427069 |
D |
|
Class A Common Stock |
3/15/2023 |
|
F |
|
41122 (2) |
D |
$9.01 |
385947 |
D |
|
Class A Common Stock |
|
|
|
|
|
|
|
1500 |
I |
Held by Trustees of Richard M. Dudum Irrevocable
1 U/A dtd 10/15/1997 |
Class A Common Stock |
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|
|
|
|
|
|
81100 |
I |
Held by Trustee of Dudum Family Community
Property Trust |
Class A Common Stock |
|
|
|
|
|
|
|
2874769 |
I |
Held by Trustee of Dudum Family Heritage Trust
UAD 8-10-2021 |
Class A Common Stock |
|
|
|
|
|
|
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700000 |
I |
Held by Trustee of AD 2022
GRAT |
Class A Common Stock |
|
|
|
|
|
|
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359947 |
I |
Held by Trustee of Andrew Dudum 2015 Trust Dated
July 2, 2015 |
Class A Common Stock |
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|
|
|
|
|
|
1695815 |
I |
Held by Trustee of AD 2022 GRAT
3 |
Class A Common Stock |
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|
|
|
|
|
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660837 |
I |
Held by Trustee of AD 2021 GRAT 2 dated
11-1-2021 |
Class A Common Stock |
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|
|
|
|
|
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2643348 |
I |
Held by Trustee of AD 2021 GRAT dated
11-1-2021 |
Class A Common Stock |
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|
|
|
|
|
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1047164 |
I |
Held by Trustee of AD 2022 GRAT 2 dated
9/7/2022 |
Class A Common Stock |
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|
|
|
|
|
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1121033 |
I |
Held by Trustee of the AD GRAT dated
8/31/20 |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
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 |
Restricted Stock Unit |
(1) |
3/15/2023 |
|
M |
|
|
9923 |
(3) |
(3) |
Class A Common Stock |
9923.0 |
$0 |
39693 |
D |
|
Restricted Stock Unit |
(1) |
3/15/2023 |
|
M |
|
|
198 |
(3) |
(3) |
Class A Common Stock |
198.0 |
$0 |
790 |
D |
|
Restricted Stock Unit |
(1) |
3/15/2023 |
|
M |
|
|
108 |
(4) |
(4) |
Class A Common Stock |
108.0 |
$0 |
854 |
D |
|
Restricted Stock Unit |
(1) |
3/15/2023 |
|
M |
|
|
7330 |
(4) |
(4) |
Class A Common Stock |
7330.0 |
$0 |
58640 |
D |
|
Restricted Stock Unit |
(1) |
3/15/2023 |
|
M |
|
|
3575 |
(4) |
(4) |
Class A Common Stock |
3575.0 |
$0 |
28603 |
D |
|
Restricted Stock Unit |
(1) |
3/15/2023 |
|
M |
|
|
1789 |
(4) |
(4) |
Class A Common Stock |
1789.0 |
$0 |
14312 |
D |
|
Restricted Stock Unit |
(1) |
3/15/2023 |
|
M |
|
|
18289 |
(4) |
(4) |
Class A Common Stock |
18289.0 |
$0 |
146313 |
D |
|
Restricted Stock Unit |
(1) |
3/15/2023 |
|
M |
|
|
35242 |
(5) |
(5) |
Class A Common Stock |
35242.0 |
$0 |
422904 |
D |
|
Explanation of
Responses: |
(1) |
The Restricted Stock Units
("RSUs") represent a contingent right to receive one share of Class
A Common Stock for each RSU. |
(2) |
The shares of Class A Common
Stock were withheld by the issuer to cover tax withholding
obligations in connection with the reported vesting and settlement
of RSUs. |
(3) |
The RSUs are subject to a
service-based vesting requirement, which shall be satisfied over a
four-year period, with 6.25% of the RSUs vesting on each of March
15, June 15, September 15 and December 15 (each, a "Company
Quarterly Vesting Date") occurring on or after March 15,
2020. |
(4) |
The RSUs are subject to a
service-based vesting requirement, which shall be satisfied over a
four-year period, with 6.25% of the RSUs vesting on each Company
Quarterly Vesting Date occurring on or after March 15,
2021. |
(5) |
The RSUs are subject to a
service-based vesting requirement, which shall be satisfied over a
four-year period, with 6.25% of the RSUs vesting on each Company
Quarterly Vesting Date occurring on or after June 15,
2022. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Dudum Andrew
2269 CHESTNUT STREET, #523
SAN FRANCISCO, CA 94123 |
X |
X |
Chief Executive Officer |
|
Signatures
|
/s/ Alexandra Cotter Wilkins,
Attorney-in-Fact |
|
3/17/2023 |
**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 4(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. |
Persons who respond to the collection of information
contained in this form are not required to respond unless the form
displays a currently valid OMB control number. |
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