1. Title of Derivate Security
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date (Month/Day/Year)
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3A. Deemed Execution Date, if any (Month/Day/Year)
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4. Transaction Code
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
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8. Price of Derivative Security
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
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11. Nature of Indirect Beneficial Ownership
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expriation Date
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Title
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Amount or Number of Shares
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(*)
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If the form is filed by more than one reporting person, see Instruction 5(b)(v).
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(**)
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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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(1)
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Received in exchange for 414,706 shares of common stock of CalciMedica, Inc. ("CalciMedica") pursuant to an Agreement and Plan of Merger and Reorganization (the "Merger Agreement") by and among CalciMedica, the Issuer and Camaro Merger Sub, Inc., a wholly-owned subsidiary of the Issuer ("Merger Sub"). Under the terms of the Merger Agreement, on March 20, 2023, Merger Sub merged with and into CalciMedica (the "Merger"), with CalciMedica surviving the Merger as a wholly-owned subsidiary of the Issuer. Upon the closing of the Merger, each share of CalciMedica common stock was converted into the right to receive 0.0288 of a share of the Issuer's common stock. Subsequent to the Merger, the name of the Issuer was changed from Graybug Vision, Inc. to CalciMedica, Inc.
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(2)
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Immediately exercisable.
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(3)
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Received in exchange for a stock option to acquire 790,880 shares of common stock of CalciMedica pursuant to the Merger Agreement.
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(4)
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Upon the closing of the Merger, each outstanding option to purchase shares of CalciMedica common stock was assumed by the Issuer and converted into an option to purchase the Issuer's common stock.
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(5)
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Received in exchange for a stock option to acquire 300,000 shares of common stock of CalciMedica pursuant to the Merger Agreement.
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(6)
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25% of the shares subject to the option vested on June 30, 2020 and the balance of the shares vest in a series of thirty-six (36) successive equal monthly installments thereafter.
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(7)
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Received in exchange for a stock option to acquire 751,649 shares of common stock of CalciMedica pursuant to the Merger Agreement.
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(8)
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Beginning on February 22, 2021, the shares subject to the option vest in a series of forty-eight (48) successive equal monthly installments.
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(9)
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Received in exchange for a stock option to acquire 252,226 shares of common stock of CalciMedica pursuant to the Merger Agreement.
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(10)
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Received in exchange for a stock option to acquire 456,522 shares of common stock of CalciMedica pursuant to the Merger Agreement.
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(11)
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Received in exchange for a stock option to acquire 190,000 shares of common stock of CalciMedica pursuant to the Merger Agreement.
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(12)
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Received in exchange for a stock option to acquire 22,977 shares of common stock of CalciMedica pursuant to the Merger Agreement.
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(13)
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Received in exchange for a stock option to acquire 67,873 shares of common stock of CalciMedica pursuant to the Merger Agreement.
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(14)
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Beginning on November 22, 2022, the shares subject to the option vest in a series of forty-eight (48) successive equal monthly installments.
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(15)
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Received in exchange for a stock option to acquire 72,589 shares of common stock of CalciMedica pursuant to the Merger Agreement.
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(16)
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Received in exchange for a stock option to acquire 659,413 shares of common stock of CalciMedica pursuant to the Merger Agreement.
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(17)
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Received in exchange for a stock option to acquire 65,191 shares of common stock of CalciMedica pursuant to the Merger Agreement.
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Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
Instruction 6 for procedure.Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.