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: Tsai Chen Lung (N/A)

Holdings (Non-Derivative)

Security	Shares	Ownership
Common Stock	80000	Indirect

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Series B Preferred Stock	$		Common Stock (71429)		Indirect
Series D-1 Preferred Stock	$		Common Stock (55555)		Indirect
Series E Preferred Stock	$		Common Stock (86956)		Indirect
Series H Preferred Stock	$		Common Stock (90534)		Indirect

Footnotes

F1: Does 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.

F2: Each share of Series B preferred stock, Series D-1 preferred stock, Series E preferred stock and Series H preferred stock (the "Preferred Stock") is convertible on a one-to-one basis into the underlying shares of common stock at the holder's election and has no expiration date. The Preferred Stock will automatically convert into common stock upon the closing of the Issuer's initial public offering. The number of underlying shares of common stock reported in Column 3 does 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 securities are held by The Tsai Family Trust, for which the Reporting Person, together with his wife, are trustees.