SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Tananbaum James B.

(Last) (First) (Middle)
C/O QUANTUM-SI INCORPORATED
530 OLD WHITFIELD STREET

(Street)
GUILFORD CT 06437

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Quantum-Si Inc [ QSI ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
06/10/2021
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Class A Common Stock 06/10/2021 A 4,463,619 A (1) 4,463,619 I Foresite Capital Fund IV, L.P.(2)
Class A Common Stock 06/10/2021 A 743,936 A (3) 743,936 I Foresite Capital Fund V, L.P.(2)
Class A Common Stock 06/10/2021 A 1,250,000(4) A $10 1,993,936 I Foresite Capital Fund V, L.P.(2)
Class A Common Stock 06/10/2021 A 348,125(5) A $0.001 2,342,061 I Foresite Capital Fund V, L.P.(2)
Class A Common Stock 06/10/2021 A 1,250,000(4) A $10 1,250,000 I By Foresite Capital Opportunity Fund V, L.P.(2)
Class A Common Stock 06/10/2021 A 348,125(5) A $0.001 1,598,125 I By Foresite Capital Opportunity Fund V, L.P.(2)
Class A Common Stock 06/11/2021 A 20,512(6) A $0.00 20,512 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. In connection with the closing of the transactions contemplated by the Business Combination Agreement, dated as of February 18, 2021, by and among HighCape Capital Acquisition Corp. ("HighCape"), Tenet Merger Sub, Inc., a Delaware corporation and wholly owned subsidiary of HighCape ("Merger Sub"), and Quantum-Si Incorporated, a Delaware corporation ("Quantum-Si"), pursuant to which Merger Sub merged with and into Quantum-Si (the "Merger"), with Quantum-Si surviving as a wholly-owned subsidiary of HighCape (which changed its name to "Quantum-Si Incorporated", the "Issuer"), these shares were received in exchange for 5,597,015 shares of Quantum-Si Series E preferred stock.
2. Foresite Capital Management IV, LLC ("FCM IV") is the general partner of Foresite Capital Fund IV, L.P. ("Foresite IV") and may be deemed to have sole voting and dispositive power over shares held by Foresite IV. Foresite Capital Management V, LLC ("FCM V") is the general partner of Foresite Capital Fund V, L.P. ("Foresite V") and Foresite Capital Opportunity Fund V, L.P. ("Foresite Opportunity") and may be deemed to have sole voting and dispositive power over shares held by Foresite V and Foresite Opportunity. Dr. Tananbaum is the sole managing member of FCM IV and FCM V and may be deemed to have sole voting and dispositive power over share held by Foresite IV, Foresite V, and Foresite Opportunity. Each of FCM IV, FCM V, Foresite Opportunity, and Dr. Tananbaum disclaims beneficial ownership of shares held by Foresite IV, Foresite V, and Foresite Opportunity except to the extent of any pecuniary interest therein.
3. Received in connection with the Merger in exchange for 932,836 shares of Quantum-Si Series E preferred stock.
4. Foresite V and Foresite Opportunity each purchased 1,250,000 shares of Class A common stock from the Issuer, at a price of $10.00 per share, in a private placement immediately prior to the closing of the Merger.
5. Foresite V and Foresite Opportunity each acquired 348,125 shares of Class A common stock from the Issuer, at a price of $0.001 per share, immediately prior to the closing of the Merger.
6. Consists of RSUs. Each RSU represents the right to receive one share of common stock upon vesting. The RSUs vest in equal annual installments over three years beginning on June 11, 2022, subject to Dr. Tananbaum's continued service through the applicable vesting date.
/s/ Christian LaPointe, Ph.D., Attorney-in-Fact 06/14/2021
** 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 4 (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).
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