CV Form 4: Insider purchase and option holdings updated after reverse split

Rhea-AI Filing Summary

CapsoVision, Inc. reporting person Rebecca Ann Petersen acquired 24,834 shares of common stock and holds stock options adjusted for a recent reverse split. The Form 4 shows a purchase of 24,834 shares at $0.3663 per share on 08/18/2025, resulting in 24,834 shares beneficially owned directly. The filing also reports two option grants (7,507 and 17,327 underlying shares) with an exercise price of $0.3663, exercisable through 10/31/2031 and 03/22/2032; the options’ share counts and exercise price reflect a 1-for-3.33 reverse stock split tied to the issuer’s IPO. One option is fully vested and the other is partially vested. The Form 4 was filed late due to an administrative error.

Positive

• Direct acquisition of 24,834 shares at $0.3663, increasing the reporting person’s direct ownership
• Restated options reflect the 1-for-3.33 reverse split, preserving prior economic terms and clarifying post-split holdings
• One option fully vested, providing immediate exercisability for that tranche

Negative

• Late Form 4 filing reported as due to an administrative error, which raises compliance and disclosure concerns

Insights

Financial Analyst

TL;DR: Insider purchased common shares and holds adjusted options after a reverse split; transactions are routine but noteworthy for ownership changes.

The reported acquisition of 24,834 shares at $0.3663 is a direct purchase that increases the reporting person’s stake at a modest price per share. The options reported (7,507 and 17,327 underlying shares) have exercise prices and share counts restated to reflect a 1-for-3.33 reverse split, preserving prior economic terms while changing nominal amounts. One option is fully vested, supporting immediate exercisability for that tranche, while the other remains partially vested. These items change insider alignment with equity but do not on their face indicate material corporate developments.

Corporate Governance Expert

TL;DR: Transactions are standard insider activity, but the late filing raises governance and compliance concerns.

The substance of the Form 4—an insider purchase and option holdings adjusted for a reverse split—is routine. However, the report discloses the Form 4 was filed late due to an administrative error. Timely Section 16 reporting is a compliance expectation; late reporting can reduce transparency for investors and may warrant internal process review. The reverse-split adjustments are documented, which helps maintain clarity on post-split economics.

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).

Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

1. Name and Address of Reporting Person^*

Petersen Rebecca Ann

(Last) (First) (Middle)

C/O CAPSOVISION, INC.

18805 COX AVENUE, SUITE 250

(Street)

SARATOGA CA 95070

(City) (State) (Zip)

2. Issuer Name and Ticker or Trading Symbol
CapsoVision, Inc [ CV ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director		10% Owner
X	Officer (give title below)		Other (specify below)
	Director of Clinical Affairs

3. Date of Earliest Transaction (Month/Day/Year)
08/18/2025

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
Common Stock	08/18/2025		M		24,834	A	$0.3663	24,834	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
Stock Option (right to buy)	$0.3663(1)	08/18/2025		M			7,507	(2)	10/31/2031	Common Stock	7,507(3)	$0	0(3)	D
Stock Option (right to buy)	$0.3663(1)	08/18/2025		M			17,327	(4)	03/22/2032	Common Stock	17,327(3)	$0	3,694(3)	D

Explanation of Responses:

1. These options were previously reported at exercise price of $0.11 per share. The exercise price reported herein gives effect to a 1-for-3.33 reverse stock split effected by the Issuer on July 2, 2025 in connection with its initial public offering.

2. The option was granted on October 28, 2021 and is fully vested and exercisable as of the transaction date.

3. There options were previously reported as covering 25,000 and 70,000 shares, respectively. The number of shares reported herein gives effect to a 1-for-3.33 reverse stock split effected by the Issuer on July 2, 2025 in connection with its initial public offering.

4. The option was granted on March 23, 2022 and is partially vested and exercisable as of the transaction date.

Remarks:

The Form 4 is being filed late due to an inadvertent administrative error.

	/s/ Tai Vivatvaraphol, Attorney-in-Fact for Rebecca Petersen	08/22/2025
	** 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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FAQ

What transactions did Rebecca Ann Petersen report for CapsoVision (CV)?

The Form 4 reports a purchase of 24,834 common shares at $0.3663 on 08/18/2025 and two stock options covering 7,507 and 17,327 underlying shares adjusted for a reverse split.

How did the 1-for-3.33 reverse split affect the reported options?

The filing states the exercise price and share counts were restated to reflect the 1-for-3.33 reverse stock split effected on July 2, 2025, changing nominal amounts while preserving economic terms.

Are any of the reported options exercisable immediately?

Yes. The option covering 7,507 underlying shares (granted October 28, 2021) is reported as fully vested and exercisable on the transaction date; the other option is partially vested.

Was the Form 4 filed on time?

No. The Form 4 includes a remark that it was filed late due to an inadvertent administrative error.

What are the expiration dates for the reported options?

The filing lists expiration dates of 10/31/2031 for the 7,507-share option and 03/22/2032 for the 17,327-share option.