|
Delaware |
|
|
001-36305 |
|
|
26-1367393 |
|
---|---|---|---|---|---|---|---|---|
|
(State or other jurisdiction of incorporation) |
|
|
(Commission File Number) |
|
|
(IRS Employer Identification No.) |
|
| | | | | |
|
2330 NW Everett St. Portland, Oregon |
|
|
97210 |
|
---|---|---|---|---|---|
|
(Address of principal executive offices) |
|
|
(Zip Code) |
|
| | | |
|
Name and Principal Position |
|
|
Fiscal Year |
|
|
Salary |
|
|
Bonus(2) |
|
|
Stock Award(s) |
|
|
Option Award(s)(3) |
|
|
All Other Compensation(4)(5) |
|
|
Total |
| ||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Douglas Murphy-Chutorian, M.D. Director and CEO(1) |
|
|
|
|
2013 |
|
|
|
|
$ |
32,000 |
|
|
|
|
$ |
0 |
|
|
|
|
$ |
0 |
|
|
|
|
$ |
0 |
|
|
|
|
$ |
286,305 |
|
|
|
|
$ |
318,305 |
|
| |||||||
|
|
|
2012 |
|
|
|
|
$ |
0 |
|
|
|
|
$ |
0 |
|
|
|
|
$ |
0 |
|
|
|
|
$ |
6,400 |
|
|
|
|
$ |
786,116 |
|
|
|
|
$ |
792,516 |
|
| ||||||||||
|
Robert G. McRae Chief Operating Officer |
|
|
|
|
2013 |
|
|
|
|
$ |
218,295 |
|
|
|
|
$ |
54,300 |
|
|
|
|
$ |
0 |
|
|
|
|
$ |
0 |
|
|
|
|
$ |
20,915 |
|
|
|
|
$ |
293,510 |
|
| |||||||
|
|
|
2012 |
|
|
|
|
$ |
207,488 |
|
|
|
|
$ |
51,975 |
|
|
|
|
$ |
0 |
|
|
|
|
$ |
70,200 |
|
|
|
|
$ |
23,182 |
|
|
|
|
$ |
352,845 |
|
| ||||||||||
|
Daniel E. Conger Vice President of Finance |
|
|
|
|
2013 |
|
|
|
|
$ |
121,275 |
|
|
|
|
$ |
30,300 |
|
|
|
|
$ |
0 |
|
|
|
|
$ |
0 |
|
|
|
|
$ |
0 |
|
|
|
|
$ |
151,575 |
|
| |||||||
|
|
|
2012 |
|
|
|
|
$ |
115,271 |
|
|
|
|
$ |
28,875 |
|
|
|
|
$ |
0 |
|
|
|
|
$ |
23,935 |
|
|
|
|
$ |
0 |
|
|
|
|
$ |
168,081 |
|
| ||||||||||
| | | | | | | | | | | | | | | | | | | | | | | |
|
Name |
|
|
Number of Securities Underlying Unexercised Options (#) Exercisable |
|
|
Option Exercise Price ($) |
|
|
Option Expiration Date |
| ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Douglas Murphy-Chutorian |
|
|
|
|
20,000 |
|
|
|
|
$ |
0.52 |
|
|
|
|
|
11/21/2022 |
|
| |||
|
Robert G. McRae |
|
|
|
|
20,000 |
|
|
|
|
$ |
0.52 |
|
|
|
|
|
11/1/2020 |
|
| |||
|
Robert G. McRae |
|
|
|
|
20,000 |
|
|
|
|
$ |
0.52 |
|
|
|
|
|
6/10/2021 |
|
| |||
|
Robert G. McRae |
|
|
|
|
20,000 |
|
|
|
|
$ |
0.52 |
|
|
|
|
|
1/5/2022 |
|
| |||
|
Robert G. McRae |
|
|
|
|
20,000 |
|
|
|
|
$ |
0.52 |
|
|
|
|
|
11/21/2022 |
|
| |||
|
Daniel E. Conger |
|
|
|
|
6,500 |
|
|
|
|
$ |
0.52 |
|
|
|
|
|
11/1/2020 |
|
| |||
|
Daniel E. Conger |
|
|
|
|
6,500 |
|
|
|
|
$ |
0.52 |
|
|
|
|
|
6/10/2021 |
|
| |||
|
Daniel E. Conger |
|
|
|
|
6,500 |
|
|
|
|
$ |
0.52 |
|
|
|
|
|
1/5/2022 |
|
| |||
|
Daniel E. Conger |
|
|
|
|
10,000 |
|
|
|
|
$ |
0.52 |
|
|
|
|
|
11/21/2022 |
|
| |||
| | | | | | | | | | | |
|
Name and Address of Beneficial Owner |
|
|
Number of Shares of Common Stock Beneficially Owned |
|
|
Percentage of Shares Beneficially Owned |
| ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
5% Stockholders |
|
|
|
|
|
|
| | | | | | | | |
|
William H.C. Chang(1) |
|
|
|
|
814,473 |
|
|
|
|
|
17.3 |
% |
|
| |
|
Eric Semler |
|
|
|
|
568,221 |
|
|
|
|
|
12.1 |
% |
|
| |
|
Sabby Management LLC(2) |
|
|
|
|
251,222 |
|
|
|
|
|
5.3 |
% |
|
| |
|
Executive Officers and Directors: |
|
|
|
|
|
|
| | | | | | | | |
|
Dr. & Mrs. Semler(3) |
|
|
|
|
787,891 |
|
|
|
|
|
16.2 |
% |
|
| |
|
Bruce J Barclay(4) |
|
|
|
|
10,000 |
|
|
|
|
|
* |
% |
|
| |
|
Aidan M. Collins(5) |
|
|
|
|
10,000 |
|
|
|
|
|
* |
% |
|
| |
|
Greg S. Garfield(6) |
|
|
|
|
22,000 |
|
|
|
|
|
* |
% |
|
| |
|
Dr. Arthur N. Liebowitz(7) |
|
|
|
|
10,000 |
|
|
|
|
|
* |
% |
|
| |
|
Dr. Douglas Murphy-Chutorian(8) |
|
|
|
|
315,685 |
|
|
|
|
|
6.4 |
% |
|
| |
|
Dr. Wayne T. Pan(9) |
|
|
|
|
10,000 |
|
|
|
|
|
* |
% |
|
| |
|
Robert G. McRae(10) |
|
|
|
|
80,000 |
|
|
|
|
|
* |
% |
|
| |
|
Daniel E. Conger(11) |
|
|
|
|
29,500 |
|
|
|
|
|
* |
|
| ||
|
James M. Walker |
|
|
|
|
— |
|
|
|
|
|
— |
|
| ||
|
All Directors and Officers as a group (11 persons) |
|
|
|
|
1,275,076 |
|
|
|
|
|
24.1 |
% |
|
| |
| | | | | | | | |
|
|
|
|
Semler Scientific, Inc. |
|
|
Dated: September 2, 2014 |
|
|
/s/ Douglas Murphy-Chutorian, M.D. Douglas Murphy-Chutorian, M.D. Chief Executive Officer and Director |
|
| | | |
|
STOCKHOLDERS: |
| |||
|
CHANG FAMILY TRUST |
| |||
|
By: |
|
|
/s/ William H.C. Chang |
|
|
|
|
|
William H.C. Chang, Co-Trustee |
|
|
By: |
|
|
/s/ Diana S. Chang |
|
|
|
|
|
Diana S. Chang, Co-Trustee |
|
|
IRREVOCABLE TRUST FOR KELLY L. CHANG |
| |||
|
By: |
|
|
/s/ Richard Shon |
|
|
|
|
|
Richard Shon, Trustee |
|
|
IRREVOCABLE TRUST FOR KIMBERLY E. CHANG |
| |||
|
By: |
|
|
/s/ Richard Shon |
|
|
|
|
|
Richard Shon, Trustee |
|
|
IRREVOCABLE TRUST FOR KRISTINA C. CHANG |
| |||
|
By: |
|
|
/s/ Richard Shon |
|
|
|
|
|
Richard Shon, Trustee |
|
|
SEMLER TRUST |
| |||
|
By: |
|
|
/s/ Herbert J. Semler |
|
|
|
|
|
Herbert J. Semler, Co-Trustee |
|
|
By: |
|
|
/s/ Shirley L. Semler |
|
|
|
|
|
Shirley L. Semler, Co-Trustee |
|
|
ERIC SEMLER |
| |||
|
/s/ Eric Semler |
| |||
|
SHELLI JOY SEMLER |
| |||
|
/s/ Shelli Joy Semler |
| |||
| | | |
|
GPG SSF INVESTMENT LLC |
| |||
|
By: |
|
|
GREEN PARK & GOLF VENTURES, LLC, its managing member |
|
| | | |
|
By: |
|
|
/s/ Clay M. Heighten |
|
|
|
|
|
Clay M. Heighten, M.D., Managing Director |
|
|
By: |
|
|
/s/ Carl D. Soderstrom |
|
|
|
|
|
Carl D. Soderstrom, Managing Director |
|
| | | |
|
WILLIAM G. MARR TRUST DATED 10/90 |
| |||
|
By: |
|
|
/s/ William G. Marr |
|
|
|
|
|
William G. Marr, Trustee |
|
| | | |