# EDGAR Filing Document

**Accession Number:** 0001807166
**File Stem:** 0001213900-23-000979
**Filing Date:** 2023-1
**Character Count:** 9015
**Document Hash:** 874acf4f051e4607de0c4e87632b48ea
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001213900-23-000979.hdr.sgml**: 20230105

**ACCESSION NUMBER**: 0001213900-23-000979

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 2

**CONFORMED PERIOD OF REPORT**: 20221230

**FILED AS OF DATE**: 20230105

**DATE AS OF CHANGE**: 20230105

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** OMENN GILBERT S
- **CENTRAL INDEX KEY:** 0001184227

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-39553
- **FILM NUMBER:** 23509671

**MAIL ADDRESS:**
- **STREET 1:** AMGEN INC.
- **STREET 2:** ONE AMGEN CENTER DRIVE
- **CITY:** THOUSAND OAKS
- **STATE:** CA
- **ZIP:** 91320-1799
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Amesite Inc.
- **CENTRAL INDEX KEY:** 0001807166
- **STANDARD INDUSTRIAL CLASSIFICATION:** SERVICES-PREPACKAGED SOFTWARE [7372]
- **IRS NUMBER:** 823431717
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 0630

**BUSINESS ADDRESS:**
- **STREET 1:** 205 EAST WASHINGTON STREET
- **STREET 2:** SUITE B
- **CITY:** ANN ARBOR
- **STATE:** MI
- **ZIP:** 48104
- **BUSINESS PHONE:** (650) 516-7633

**MAIL ADDRESS:**
- **STREET 1:** 205 EAST WASHINGTON STREET
- **STREET 2:** SUITE B
- **CITY:** ANN ARBOR
- **STATE:** MI
- **ZIP:** 48104

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** Amesite Operating Co
- **DATE OF NAME CHANGE:** 20200318

## Exhibit 24.1

**Exhibit 24.1**

**POWER OF ATTORNEY**

The undersigned, as a Section 16 reporting person of Amesite Inc. (the "Company"), hereby constitutes and appoints each of Ann Marie Sastry, Ph.D. and Sherrie Farrell as the undersigned's true and lawful attorneys-in-fact to:

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;1. complete and execute Forms 3, 4 and 5 and other forms and
all amendments thereto as such attorney-in-fact shall in their discretion determine to be required or advisable pursuant to Section
16 of the Securities Exchange Act of 1934, as amended, and the rules and regulations promulgated thereunder, or any successor laws and
regulations, as a consequence of the undersigned's ownership, acquisition or disposition of securities of the Company;

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;2. do all acts necessary in order
to file such forms with the Securities and Exchange Commission, any securities exchange or national association, the Company and such
other person or agency as the attorney-in-fact shall deem appropriate; and

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;3. take any other action of any
type whatsoever in connection with the foregoing that, in the opinion of such attorneys-in-fact, may be of benefit to, in the best interests
of, or legally required by the undersigned, it being understood that the documents executed by such attorneys-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact
may approve in such attorney-in-fact's discretion.

The undersigned hereby ratifies and confirms all that said attorneys-in-fact and agents shall do or cause to be done by virtue hereof. The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended.

This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the Company and the foregoing attorneys-in-fact.

IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of January 4, 2023.

---

| | |
|:---|:---|
| Signature: | /s/ Gilbert S. Omenn, M.D., Ph.D. |
| Print Name: | Gilbert S. Omenn, M.D., Ph.D. |

---

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] 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**<sup>*</sup><br>OMENN GILBERT S<br><sub>(Last) (First) (Middle)</sub><br>C/O AMESITE INC.<br>607 SHELBY STREET, SUITE 700 PMB 214<br><sub>(Street)</sub><br>DETROIT, MI 48226<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2022-12-30 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [ ] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Amesite Inc. [ AMST ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
|  |  |  |  |  |  |  |  |  |  |  |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Restricted Stock Units | <sup>(1)</sup> | 2022-12-30 |  | A |  | 68571 |  | <sup>(2)</sup> | <sup>(2)</sup> | Common Stock | 68571 | $0 | 165504 | I | By Gilbert S. Omenn Revocable Trust |

---

### Footnotes:

(1) Each restricted stock unit ("RSU") represents a contingent right to receive one share of AMST common stock and/or the cash equivalent of such share.

(2) The reported securities were issued as "deferred stock units" in lieu of cash compensation earned for services as a director, and the number of deferred stock units received was calculated based on the closing share price on the last day of the quarter. The deferred stock units or cash equivalent will be issued to the reporting person upon completion of service as a member of the board of directors or, if earlier, a change in control.

**Remarks:**
Exhibit 24.1 Power of Attorney

**Signature:** /s/ Sherrie Farrell, Attorney-in-Fact  
**Date:** 2023-01-05

### Remarks:

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.

**Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.**