SEC FORM 4 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).
1. Name and Address of Reporting Person*
Mayerhofer Kathy

(Last) (First) (Middle)
7529 STANDISH PLACE
SUITE 200

(Street)
DERWOOD MD 20855

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Xometry, Inc. [ XMTR ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Sales Officer
3. Date of Earliest Transaction (Month/Day/Year)
07/02/2021
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 07/02/2021 J(1) 76,249 D (1) 0(1) D
Class A Common Stock 07/02/2021 J(1) 76,249 A (1) 76,249(1) 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) $1.26 07/02/2021 J 1,042 (2) 03/22/2027 Common Stock(1) 1,042 $0.00 0 D
Stock Option (right to buy) $1.26 07/02/2021 J 1,042 (2) 03/22/2027 Class A Common Stock 1,042 $0.00 1,042 D
Stock Option (right to buy) $1.65 07/02/2021 J 1,146 (3) 01/29/2028 Common Stock(1) 1,146 $0.00 0 D
Stock Option (right to buy) $1.65 07/02/2021 J 1,146 (3) 01/29/2028 Class A Common Stock 1,146 $0.00 1,146 D
Stock Option (right to buy) $1.68 07/02/2021 J 21,563 (4) 02/19/2029 Common Stock(1) 21,563 $0.00 0 D
Stock Option (right to buy) $1.68 07/02/2021 J 21,563 (4) 02/19/2029 Class A Common Stock 21,563 $0.00 21,563 D
Stock Option (right to buy) $3.65 07/02/2021 J 20,000 (5) 04/27/2030 Common Stock(1) 20,000 $0.00 0 D
Stock Option (right to buy) $3.65 07/02/2021 J 20,000 (5) 04/27/2030 Class A Common Stock 20,000 $0.00 20,000 D
Stock Option (right to buy) $12.32 07/02/2021 J 55,000 (6) 03/25/2031 Common Stock(1) 55,000 $0.00 0 D
Stock Option (right to buy) $12.32 07/02/2021 J 55,000 (6) 03/25/2031 Class A Common Stock 55,000 $0.00 55,000 D
Explanation of Responses:
1. Immediately prior to the closing of the Issuer's initial public offering, each share of Common Stock was reclassified into one share of Class A Common Stock in an exempt transaction pursuant to Rule 16b-7.
2. Fully Vested.
3. One quarter (1/4) of the shares vested on January 1, 2019, and thereafter, the remainder of the shares vest in 36 equal monthly installments, subject to the Reporting Person's continuous service.
4. One quarter (1/4) of the shares vested on January 1, 2020, and thereafter, the remainder of the shares vest in 36 equal monthly installments, subject to the Reporting Person's continuous service.
5. One quarter (1/4) of the shares vested on January 1, 2021, and thereafter, the remainder of the shares vest in 36 equal monthly installments, subject to the Reporting Person's continuous service.
6. One quarter (1/4) of the shares shall vest on January 1, 2022, and thereafter, the remainder of the shares shall vest in 36 equal monthly installments, subject to the Reporting Person's continuous service.
Remarks:
/s/ Dorothy Vinsky, Attorney-in-Fact 07/07/2021
** 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).
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