Initial Statement of Beneficial Ownership (3)
01 November 2019 - 11:39PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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BLAKE PAUL |
2. Date of Event Requiring Statement (MM/DD/YYYY)
10/21/2019
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3. Issuer Name and Ticker or Trading Symbol
CV Sciences, Inc. [CVSI]
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(Last)
(First)
(Middle)
10070 BARNES CANYON ROAD |
4. 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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(Street)
SAN DIEGO, CA 92121
(City)
(State)
(Zip)
| 5. 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
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Table I - Non-Derivative Securities Beneficially Owned
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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 | $0 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
Employee Stock Option (right to buy) | (1) | 10/20/2029 | Common Stock | 109000.0 | $2.18 | D | |
Explanation of Responses: |
(1) | The option is durational-based. No option shares are vested on the date of grant and the remaining option shares vest and become exercisable in three successive equal annual installments from October 21, 2019, provided, however, that there has not been a termination of service as of each such date. In no event will the option become exercisable for any additional option shares after a termination of service. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
BLAKE PAUL 10070 BARNES CANYON ROAD SAN DIEGO, CA 92121 | X |
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Signatures
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/s/ Joerg Grasser as Attorney-in-fact for Paul Blake | | 11/1/2019 |
**Signature of Reporting Person | Date |
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