CapsoVision, Inc — Director's Dealing 2025

Jul 2, 2025

SEC Form 3 — Initial Statement of Beneficial Ownership

Issuer: CapsoVision, Inc (CV)
CIK: 0001378325
Period of Report: 2025-07-01

Reporting Person: Petersen Rebecca Ann (N/A)

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Stock Option (right to buy)	$0.110	2031-10-27	Common Stock (25000)		Direct
Stock Option (right to buy)	$0.110	2032-03-22	Common Stock (70000)		Direct

Footnotes

F1: The derivative security is fully vested.

F2: The number of underlying shares of common stock reported in Column 3 and the exercise price reported in Column 4 do not reflect a one-for-3.33 reverse stock split, to be effective immediately prior to the closing to the Issuer's initial public offering.

F3: The options vested as to 25% of the shares on April 1, 2023 and as to the remaining 75% of the shares in 36 equal monthly installments thereafter through April 1, 2026, subject to continued service to the Issuer on each such date. The options, to the extent then outstanding and unvested, will vest in full upon a change in control of the Issuer.