Sec Form 4 Filing - Steinmetz Nicole Franziska @ Mosaic ImmunoEngineering Inc. - 2021-01-29

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Steinmetz Nicole Franziska
2. Issuer Name and Ticker or Trading Symbol
Mosaic ImmunoEngineering Inc. [ CPMV]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Acting CSO
(Last) (First) (Middle)
1537 SOUTH NOVATO BLVD., #5
3. Date of Earliest Transaction (MM/DD/YY)
01/29/2021
(Street)
NOVATO, CA94947
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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
Common Stock 01/29/2021 C 1,641,252 A 1,641,252 D
Common Stock 01/29/2021 C 570,870 A 570,870 I By spouse.
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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 of Derivative Security: 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
Series A Convertible Voting Preferred Stock ( 1 ) ( 2 ) 01/29/2021 C 161,000 ( 1 ) ( 2 ) Common Stock 1,641,252 ( 1 ) 0 D
Series A Convertible Voting Preferred Stock ( 1 ) ( 2 ) 01/29/2021 C 56,000 ( 1 ) ( 2 ) Common Stock 570,870 ( 1 ) 0 I By spouse
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Steinmetz Nicole Franziska
1537 SOUTH NOVATO BLVD., #5
NOVATO, CA94947
X X Acting CSO
Signatures
/s/ Paul Lytle, as attorney-in-fact for Nicole Steinmetz 01/29/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Each share of the Series A Convertible Voting Preferred Stock automatically converted for no additional consideration into 10.194106 shares of common stock on January 29, 2021, the date that both of the following criteria were met: (i) upon the Registrant having a sufficient number of authorized and unissued shares of common stock so as to permit the conversion of all outstanding shares of the Series A Convertible Voting Preferred Stock into common stock, which occurred on December 2, 2020 in conjunction with the reverse stock split; and (ii) the effectiveness of any registration statement registering the resale of the underlying shares of common stock of the Registrant, which occurred on January 29, 2021.
( 2 )The Series A Convertible Voting Preferred Stock has no expiration 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).
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