Form 4 for PFSA Profusa, Inc.
Accepted 2026-08-19 20:13:53 ET · period of report 2026-08-12 · accession 0001213900-26-091839 · 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| DI | 2026-08-19 20:13 | 2026-08-12 | PFSA | STOVER JACK E | CEO | C - Cnv Deriv | $4.28 | +302.0K | 302.0K | New | +$1.29M |
| DI | 2026-08-19 20:13 | 2026-08-12 | PFSA | STOVER JACK E | CEO | C - Cnv Deriv | — | 0 | 577.3K | New | — |
Purchase Sale Sale after option exercise All abbreviations
Every reported transaction
| # | Table | Security | Date | Code | A/D | Shares | Price | Owned after | Own | Exercise / expiry | Underlying | Footnotes |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Common | Common Stock | 2026-08-12 | C | A | 301,991 | $4.28 | 301,991 | I By NorthView Sponsor I LLC | — | — | (F1) On August 12, 2026, 1,207,964 shares of Common Stock were issued upon conversion of a portion of the Convertible Promissory Note. Following a 1-for-4 reverse stock split effected after the conversion, the number of shares held became 301,991. (F2) The conversion price is equal to the higher of (i) $1.07 and (ii) the closing price of the Common Stock on the trading day immediately preceding the delivery of the Conversion Notice, as reported on The Nasdaq Stock Market, pursuant to Amendment No. 3 to the Note Modification and Conversion Agreement dated August 12, 2026. The pre-split conversion price of $1.07 per share is equivalent to $4.28 per share on a post-split basis following the 1-for-4 reverse stock split. (F1) On August 12, 2026, 1,207,964 shares of Common Stock were issued upon conversion of a portion of the Convertible Promissory Note. Following a 1-for-4 reverse stock split effected after the conversion, the number of shares held became 301,991. (F3) Jack Stover is a manager of NorthView Sponsor I LLC and may be deemed to share beneficial ownership of the securities held by NorthView Sponsor I LLC. Mr. Stover disclaims beneficial ownership of such securities except to the extent of his pecuniary interest therein. |
| 2 | Derivative | Convertible Promissory Note | 2026-08-12 | C | D | — | $0.00 | 577,275 | I By NorthView Sponsor I LLC | $4.28 · 2026-05-04 to 2026-12-31 | 301,991 Common Stock | (F2) The conversion price is equal to the higher of (i) $1.07 and (ii) the closing price of the Common Stock on the trading day immediately preceding the delivery of the Conversion Notice, as reported on The Nasdaq Stock Market, pursuant to Amendment No. 3 to the Note Modification and Conversion Agreement dated August 12, 2026. The pre-split conversion price of $1.07 per share is equivalent to $4.28 per share on a post-split basis following the 1-for-4 reverse stock split. (F4) Represents the conversion of $1,292,521 principal amount of the Convertible Promissory Note into 1,207,964 shares of Common Stock (301,991 shares on a post-split basis), reflecting conversion at the $1.07 per share ($4.28 per share on a post-split basis) price pursuant to the Conversion Notice dated August 12, 2026. (F5) The Note became convertible on May 4, 2026 (the Registration Effective Date), pursuant to Section 2.1 of the Note Modification and Conversion Agreement dated April 24, 2026. (F1) On August 12, 2026, 1,207,964 shares of Common Stock were issued upon conversion of a portion of the Convertible Promissory Note. Following a 1-for-4 reverse stock split effected after the conversion, the number of shares held became 301,991. (F6) Represents the remaining principal balance of the Note following conversion. (F3) Jack Stover is a manager of NorthView Sponsor I LLC and may be deemed to share beneficial ownership of the securities held by NorthView Sponsor I LLC. Mr. Stover disclaims beneficial ownership of such securities except to the extent of his pecuniary interest therein. |