SEC Form 3 filed by new insider Miles Mark Alan
$QIPT
Misc Health and Biotechnology Services
Health Care
| 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 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 10/01/2024 |
3. Issuer Name and Ticker or Trading Symbol
Quipt Home Medical Corp. [ QIPT ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Beneficially Owned | |||
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| 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) |
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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| 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 | ||||
| Stock Option (right to buy) | (1) | 04/09/2028 | Common Shares | 12,500 | $1.11(1) | D | |
| Stock Option (right to buy) | (2) | 05/20/2031 | Common Shares | 30,000 | $6.27(2) | D | |
| Stock Option (right to buy) | (3) | 02/20/2033 | Common Shares | 15,000 | $6.14(3) | D | |
| Explanation of Responses: |
| 1. The exercise price for this award is denominated in Canadian dollars at 1.50. All these options have vested according to the award agreement and are, as of October 1, 2024, exercisable. Converted from Canadian dollars to United States dollars as of the date hereof at a conversion rate of 0.74 United States dollars per Canadian dollar. |
| 2. The exercise price for this award is denominated in Canadian dollars at 8.48. All these options have vested according to the award agreement and are, as of October 1, 2024, exercisable. Converted from Canadian dollars to United States dollars as of the date hereof at a conversion rate of 0.74 United States dollars per Canadian dollar. |
| 3. The exercise price for this award is denominated in Canadian dollars at 8.30. Options to purchase 7,500 Common Shares have vested according to the award agreement and are, as of October 1, 2024, exercisable. Options to purchase 1,250 Common Shares will vest on each of November 20, 2024, February 20, 2025, May 20, 2025, August 20, 2025, November 20, 2025, and February 20, 2026. Converted from Canadian dollars to United States dollars as of the date hereof at a conversion rate of 0.74 United States dollars per Canadian dollar. |
| Remarks: |
| Quipt Home Medical Corp. (the "Issuer") has determined that it ceased to be a "foreign private issuer" as of March 31, 2024. As a result, effective October 1, 2024, the Issuer is required to comply with the reporting requirements and use the filing forms applicable to U.S. public companies under U.S. securities laws, including reports required under Section 16 of the U.S. Securities Exchange Act of 1934. |
| /s/ Mark Alan Miles | 10/01/2024 | |
| ** 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. | ||