SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
FRANK DAVID A

(Last) (First) (Middle)
C/O AQUABOUNTY TECHNOLOGIES, INC.
TWO MILL AND MAIN PLACE, SUITE 395

(Street)
MAYNARD MA 01754

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/30/2016
3. Issuer Name and Ticker or Trading Symbol
AquaBounty Technologies, Inc. [ AQB ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
See Remarks
5. If Amendment, Date of Original Filed (Month/Day/Year)
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 Beneficially Owned
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)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: 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
Options to Purchase Common Stock 07/01/2012(1) 07/01/2019 Common Stock 150,000 0.11 D
Options to Purchase Common Stock 07/01/2012(2) 07/01/2019 Common Stock 300,000 0.11 D
Options to Purchase Common Stock 01/11/2014(3) 01/11/2021 Common Stock 150,000 0.23 D
Options to Purchase Common Stock 04/27/2016(4) 04/27/2023 Common Stock 200,000 0.25 D
Options to Purchase Common Stock 01/20/2017(5) 01/20/2024 Common Stock 200,000 0.78 D
Explanation of Responses:
1. Options to purchase common stock were granted on 7/1/2009 pursuant to the AquaBounty Technologies, Inc. 2006 Equity Incentive Plan and have fully vested.
2. Options to purchase common stock were granted on 7/1/2009 pursuant to the AquaBounty Technologies, Inc. 2006 Equity Incentive Plan and have fully vested.
3. Options to purchase common stock were granted on 1/11/2011 pursuant to the AquaBounty Technologies, Inc. 2006 Equity Incentive Plan and have fully vested.
4. Options to purchase common stock were granted on 4/27/2013 pursuant to the AquaBounty Technologies, Inc. 2006 Equity Incentive Plan and have fully vested.
5. Options to purchase common stock were granted on 1/20/2014 pursuant to the AquaBounty Technologies, Inc. 2006 Equity Incentive Plan and fully vest three years after grant date.
Remarks:
Chief Financial Officer and Treasurer Exhibit List - Exhibit 24.1 - Power of Attorney.
/s/ David A. Frank, Name: David A. Frank 12/30/2016
** 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 5 (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 Number.