Amendment: SEC Form 1-A/A filed by Tivic Health Systems Inc.
Form 1-A Issuer Information |
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 1-A REGULATION A OFFERING STATEMENT UNDER THE SECURITIES ACT OF 1933 | OMB APPROVAL |
| OMB Number: 3235-0286 Estimated average burden hours per response: 608.0 |
1-A: Filer Information
Issuer CIK | 0001787740 |
Issuer CCC | XXXXXXXX |
DOS File Number | |
Offering File Number | 024-12489 |
Is this a LIVE or TEST Filing? | LIVE TEST |
Would you like a Return Copy? | |
Notify via Filing Website only? | |
Since Last Filing? |
Submission Contact Information
Name | |
Phone | |
E-Mail Address |
1-A: Item 1. Issuer Information
Issuer Infomation
Exact name of issuer as specified in the issuer's charter | Tivic Health Systems, Inc. |
Jurisdiction of Incorporation / Organization |
DELAWARE
|
Year of Incorporation | 2016 |
CIK | 0001787740 |
Primary Standard Industrial Classification Code | ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS |
I.R.S. Employer Identification Number | 81-4016391 |
Total number of full-time employees | 9 |
Total number of part-time employees | 0 |
Contact Infomation
Address of Principal Executive Offices
Address 1 | 47685 LAKEVIEW BLVD |
Address 2 | |
City | FREMONT |
State/Country |
CALIFORNIA
|
Mailing Zip/ Postal Code | 94538 |
Phone | 888-276-6888 |
Provide the following information for the person the Securities and Exchange Commission's staff should call in connection with any pre-qualification review of the offering statement.
Name | Jennifer Ernst |
Address 1 | |
Address 2 | |
City | |
State/Country | |
Mailing Zip/ Postal Code | |
Phone |
Provide up to two e-mail addresses to which the Securities and Exchange Commission's staff may send any comment letters relating to the offering statement. After qualification of the offering statement, such e-mail addresses are not required to remain active.
Financial Statements
Use the financial statements for the most recent period contained in this offering statement to provide the following information about the issuer. The following table does not include all of the line items from the financial statements. Long Term Debt would include notes payable, bonds, mortgages, and similar obligations. To determine "Total Revenues" for all companies selecting "Other" for their industry group, refer to Article 5-03(b)(1) of Regulation S-X. For companies selecting "Insurance", refer to Article 7-04 of Regulation S-X for calculation of "Total Revenues" and paragraphs 5 and 7 of Article 7-04 for "Costs and Expenses Applicable to Revenues".
Industry Group (select one) | Banking Insurance Other |
Balance Sheet Information
Cash and Cash Equivalents |
$
3693000.00 |
Investment Securities |
$
0.00 |
Total Investments |
$
|
Accounts and Notes Receivable |
$
16000.00 |
Loans |
$
|
Property, Plant and Equipment (PP&E): |
$
120000.00 |
Property and Equipment |
$
|
Total Assets |
$
4783000.00 |
Accounts Payable and Accrued Liabilities |
$
446000.00 |
Policy Liabilities and Accruals |
$
|
Deposits |
$
|
Long Term Debt |
$
0.00 |
Total Liabilities |
$
591000.00 |
Total Stockholders' Equity |
$
4192000.00 |
Total Liabilities and Equity |
$
4783000.00 |
Statement of Comprehensive Income Information
Total Revenues |
$
474000.00 |
Total Interest Income |
$
|
Costs and Expenses Applicable to Revenues |
$
277000.00 |
Total Interest Expenses |
$
|
Depreciation and Amortization |
$
0.00 |
Net Income |
$
-2747000.00 |
Earnings Per Share - Basic |
$
-1.00 |
Earnings Per Share - Diluted |
$
-1.00 |
Name of Auditor (if any) | Rosenberg Rich Baker Berman, P.A. |
Outstanding Securities
Common Equity
Name of Class (if any) Common Equity | Common Stock |
Common Equity Units Outstanding | 6243403 |
Common Equity CUSIP (if any): | 888705209 |
Common Equity Units Name of Trading Center or Quotation Medium (if any) | The Nasdaq Stock Market LLC |
Common Equity
Name of Class (if any) Common Equity | Series A Warrants |
Common Equity Units Outstanding | 4710000 |
Common Equity CUSIP (if any): | 888705126 |
Common Equity Units Name of Trading Center or Quotation Medium (if any) | N/A |
Common Equity
Name of Class (if any) Common Equity | Series B Warrants |
Common Equity Units Outstanding | 7065000 |
Common Equity CUSIP (if any): | 888705118 |
Common Equity Units Name of Trading Center or Quotation Medium (if any) | N/A |
Common Equity
Name of Class (if any) Common Equity | Placement Agent Warrants |
Common Equity Units Outstanding | 188400 |
Common Equity CUSIP (if any): | 000000000 |
Common Equity Units Name of Trading Center or Quotation Medium (if any) | N/A |
Common Equity
Name of Class (if any) Common Equity | Common Warrants |
Common Equity Units Outstanding | 59497 |
Common Equity CUSIP (if any): | 000000000 |
Common Equity Units Name of Trading Center or Quotation Medium (if any) | N/A |
Preferred Equity
Preferred Equity Name of Class (if any) | N/A |
Preferred Equity Units Outstanding | 0 |
Preferred Equity CUSIP (if any) | 000000000 |
Preferred Equity Name of Trading Center or Quotation Medium (if any) | N/A |
Debt Securities
Debt Securities Name of Class (if any) | N/A |
Debt Securities Units Outstanding | 0 |
Debt Securities CUSIP (if any): | 000000000 |
Debt Securities Name of Trading Center or Quotation Medium (if any) | N/A |
1-A: Item 2. Issuer Eligibility
Issuer Eligibility
Check this box to certify that all of the following statements are true for the issuer(s)
- Organized under the laws of the United States or Canada, or any State, Province, Territory or possession thereof, or the District of Columbia.
- Principal place of business is in the United States or Canada.
- Not subject to section 13 or 15(d) of the Securities Exchange Act of 1934.
- Not a development stage company that either (a) has no specific business plan or purpose, or (b) has indicated that its business plan is to merge with an unidentified company or companies.
- Not an investment company registered or required to be registered under the Investment Company Act of 1940.
- Not issuing fractional undivided interests in oil or gas rights, or a similar interest in other mineral rights.
- Not issuing asset-backed securities as defined in Item 1101 (c) of Regulation AB.
- Not, and has not been, subject to any order of the Commission entered pursuant to Section 12(j) of the Exchange Act (15 U.S.C. 78l(j)) within five years before the filing of this offering statement.
- Has filed with the Commission all the reports it was required to file, if any, pursuant to Rule 257 during the two years immediately before the filing of the offering statement (or for such shorter period that the issuer was required to file such reports).
1-A: Item 3. Application of Rule 262
Application Rule 262
Check this box to certify that, as of the time of this filing, each person described in Rule 262 of Regulation A is either not disqualified under that rule or is disqualified but has received a waiver of such disqualification.
Check this box if "bad actor" disclosure under Rule 262(d) is provided in Part II of the offering statement.
1-A: Item 4. Summary Information Regarding the Offering and Other Current or Proposed Offerings
Summary Infomation
Check the appropriate box to indicate whether you are conducting a Tier 1 or Tier 2 offering | Tier1 Tier2 |
Check the appropriate box to indicate whether the financial statements have been audited | Unaudited Audited |
Types of Securities Offered in this Offering Statement (select all that apply) |
Equity (common or preferred stock) |
Option, warrant or other right to acquire another security |
Security to be acquired upon exercise of option, warrant or other right to acquire security |
Does the issuer intend to offer the securities on a delayed or continuous basis pursuant to Rule 251(d)(3)? | Yes No |
Does the issuer intend this offering to last more than one year? | Yes No |
Does the issuer intend to price this offering after qualification pursuant to Rule 253(b)? | Yes No |
Will the issuer be conducting a best efforts offering? | Yes No |
Has the issuer used solicitation of interest communications in connection with the proposed offering? | Yes No |
Does the proposed offering involve the resale of securities by affiliates of the issuer? | Yes No |
Number of securities offered | 10000000 |
Number of securities of that class outstanding | 6243403 |
The information called for by this item below may be omitted if undetermined at the time of filing or submission, except that if a price range has been included in the offering statement, the midpoint of that range must be used to respond. Please refer to Rule 251(a) for the definition of "aggregate offering price" or "aggregate sales" as used in this item. Please leave the field blank if undetermined at this time and include a zero if a particular item is not applicable to the offering.
Price per security |
$
2.0000 |
The portion of the aggregate offering price attributable to securities being offered on behalf of the issuer |
$
20000000.00 |
The portion of the aggregate offering price attributable to securities being offered on behalf of selling securityholders |
$
0.00 |
The portion of the aggregate offering price attributable to all the securities of the issuer sold pursuant to a qualified offering statement within the 12 months before the qualification of this offering statement |
$
0.00 |
The estimated portion of aggregate sales attributable to securities that may be sold pursuant to any other qualified offering statement concurrently with securities being sold under this offering statement |
$
0.00 |
Total (the sum of the aggregate offering price and aggregate sales in the four preceding paragraphs) |
$
20000000.00 |
Anticipated fees in connection with this offering and names of service providers
Underwriters - Name of Service Provider | Maxim Group, LLC | Underwriters - Fees |
$
60000.00 |
Sales Commissions - Name of Service Provider | Maxim Group LLC | Sales Commissions - Fee |
$
1400000.00 |
Finders' Fees - Name of Service Provider | Finders' Fees - Fees |
$
| |
Accounting or Audit - Name of Service Provider | Rosenberg Rich Baker Berman, P.A. | Accounting or Audit - Fees |
$
20000.00 |
Legal - Name of Service Provider | Procopio, Cory, Hargreaves & Savitch, LLP | Legal - Fees |
$
50000.00 |
Promoters - Name of Service Provider | Promoters - Fees |
$
| |
Blue Sky Compliance - Name of Service Provider | Blue Sky Compliance - Fees |
$
| |
CRD Number of any broker or dealer listed: | 000120708 |
Estimated net proceeds to the issuer |
$
18450000.00 |
Clarification of responses (if necessary) |
1-A: Item 5. Jurisdictions in Which Securities are to be Offered
Jurisdictions in Which Securities are to be Offered
Using the list below, select the jurisdictions in which the issuer intends to offer the securities
Selected States and Jurisdictions |
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
DISTRICT OF COLUMBIA
PUERTO RICO
ALBERTA, CANADA
BRITISH COLUMBIA, CANADA
MANITOBA, CANADA
NEW BRUNSWICK, CANADA
NEWFOUNDLAND, CANADA
NOVA SCOTIA, CANADA
ONTARIO, CANADA
PRINCE EDWARD ISLAND, CANADA
QUEBEC, CANADA
SASKATCHEWAN, CANADA
YUKON, CANADA
CANADA (FEDERAL LEVEL)
|
Using the list below, select the jurisdictions in which the securities are to be offered by underwriters, dealers or sales persons or check the appropriate box
None | |
Same as the jurisdictions in which the issuer intends to offer the securities | |
Selected States and Jurisdictions |
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
DISTRICT OF COLUMBIA
PUERTO RICO
ALBERTA, CANADA
BRITISH COLUMBIA, CANADA
MANITOBA, CANADA
NEW BRUNSWICK, CANADA
NEWFOUNDLAND, CANADA
NOVA SCOTIA, CANADA
ONTARIO, CANADA
PRINCE EDWARD ISLAND, CANADA
QUEBEC, CANADA
SASKATCHEWAN, CANADA
YUKON, CANADA
CANADA (FEDERAL LEVEL)
|
1-A: Item 6. Unregistered Securities Issued or Sold Within One Year
Unregistered Securities Issued or Sold Within One Year
None
Unregistered Securities Act
(d) Indicate the section of the Securities Act or Commission rule or regulation relied upon for exemption from the registration requirements of such Act and state briefly the facts relied upon for such exemption |