Form 4 for QTI QT IMAGING HOLDINGS, INC.

Accepted 2024-03-06 00:00:00 ET · period of report 2024-03-04 · accession 0001062993-24-005806 · SEC index · Original document

Summary rows

Aggregated the way they appear in lists: one row per insider, transaction code and security table.

X	Filed	Traded	Ticker	Insider	Title	Type	Price	Qty	Owned	ΔOwn	Value
I	2024-03-06	2024-03-04	QTI	KLOCK JOHN C JR	CEO, Dir	A - Grant	—	+2.88M	2.88M	New	—

Purchase Sale Sale after option exercise All abbreviations

#	Table	Security	Date	Code	A/D	Shares	Price	Owned after	Own	Exercise / expiry	Underlying	Footnotes
1	Common	Common Stock	2024-03-04	A	A	2,881,140	—	2,881,140	I By John C. Klock, Jr. and Cynthia L. Klock Trust Dated 7/27/07	—	—	(F1) Received in exchange for 8,407,114 shares of QT Imaging, Inc. ("QT Imaging") in connection with the merger of QT Imaging into a subsidiary of QT Imaging Holdings, Inc. (the "Company") pursuant to the exchange ratio set forth in the business combination agreement between QT Imaging and the Company. The closing price of the Company's Common Stock on the effective date of the merger was $3.53. (F2) The Common Stock are held directly by John C. Klock, Jr. and Cynthia L. Klock Trust Dated 7/27/07 (the "Trust"). The Common Stock held by the Trust are beneficially owned jointly by Dr. John C. Klock, Jr., the Company's Chief Executive Officer and Director and Cynthia L. Klock, wife of Dr. John C. Klock, Jr., who jointly have sole voting and dispositive power over the shares held by the Trust.