# EDGAR Filing Document

**Accession Number:** 0001534133
**File Stem:** 0001209191-23-016514
**Filing Date:** 2023-3
**Character Count:** 7307
**Document Hash:** 8176b60b61d98cbed495f0c667d3609e
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001209191-23-016514.hdr.sgml**: 20230306

**ACCESSION NUMBER**: 0001209191-23-016514

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230303

**FILED AS OF DATE**: 20230306

**DATE AS OF CHANGE**: 20230306

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Zamiri Parisa
- **CENTRAL INDEX KEY:** 0001824806

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-39538
- **FILM NUMBER:** 23710569

**MAIL ADDRESS:**
- **STREET 1:** C/O GRAYBUG VISION, INC.
- **STREET 2:** 275 SHORELINE DRIVE, SUITE 450
- **CITY:** REDWOOD CITY
- **STATE:** CA
- **ZIP:** 94065
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** GRAYBUG VISION, INC.
- **CENTRAL INDEX KEY:** 0001534133
- **STANDARD INDUSTRIAL CLASSIFICATION:** PHARMACEUTICAL PREPARATIONS [2834]
- **IRS NUMBER:** 452120079
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 274 REDWOOD SHORES PARKWAY
- **STREET 2:** P.O. BOX 144
- **CITY:** REDWOOD CITY
- **STATE:** CA
- **ZIP:** 94065
- **BUSINESS PHONE:** 650-487-2800

**MAIL ADDRESS:**
- **STREET 1:** 274 REDWOOD SHORES PARKWAY
- **STREET 2:** P.O. BOX 144
- **CITY:** REDWOOD CITY
- **STATE:** CA
- **ZIP:** 94065

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** GRAYBUG, Inc.
- **DATE OF NAME CHANGE:** 20150303

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** GRAYBUG LLC
- **DATE OF NAME CHANGE:** 20111102

### 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>Zamiri Parisa<br><sub>(Last) (First) (Middle)</sub><br>C/O GRAYBUG VISION, INC.<br>274 REDWOOD SHORES PARKWAY, PO BOX 144<br><sub>(Street)</sub><br>REDWOOD CITY, CA 94065<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-03-03 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [ ] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_Chief Medical Officer_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>GRAYBUG VISION, INC. [ GRAY ] | **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 |
| Common Stock | 2023-03-03 |  | M |  | 120655 | A | <sup>(1)</sup> | 178232 | D |  |
| Common Stock | 2023-03-03 |  | F |  | 42894 | D | $0.57 | 135338 | D |  |

---

## 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> | 2023-03-03 |  | M |  |  | 9375 | <sup>(2)</sup> | <sup>(3)</sup> | Common Stock | 9375 | $0.00 | 84375 | D |  |
| Restricted Stock Unit | <sup>(1)</sup> | 2023-03-03 |  | M |  |  | 83155 | <sup>(4)</sup> | <sup>(3)</sup> | Common Stock | 83155 | $0.00 | 0 | D |  |
| Restricted Stock Unit | <sup>(1)</sup> | 2023-03-03 |  | M |  |  | 28125 | <sup>(5)</sup> | <sup>(3)</sup> | Common Stock | 28125 | $0.00 | 393750 | D |  |

---

### Footnotes:

(1) Each restricted stock unit ("RSU") represents a contingent right to receive one share of the Issuer's common stock.

(2) The RSUs vested as to 1/4 of the total shares on May 19, 2022, and 1/16 of the remaining shares shall vest quarterly thereafter such that the RSUs shall be fully vested on May 19, 2025, subject to the continued service of the Reporting Person to the Issuer through each vesting date.

(3) The RSUs do not expire; they either vest or are canceled prior to vest date.

(4) The RSUs shall vested as to 100% of the total RSUs on February 28, 2023 and settled on March 3, 2023, subject to the Reporting Person's provision of service to the Issuer on each vesting date.

(5) The RSUs shall vested as to 6.25% of the total shares on November 16, 2022, and 6.25% of the remaining shares shall vest quarterly thereafter such that the RSUs shall be fully vested on August 16, 2026, subject to the continued service of the Reporting Person to the Issuer through each vesting date.

**Signature:** /s/ Frederic Guerard, as Attorney-in-Fact for Parisa Zamiri  
**Date:** 2023-03-06

### 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.**