SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

(Last) (First) (Middle)
1 GUSTAVE L. LEVY PLACE

(Street)
NEW YORK NY 10029

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/01/2023
3. Issuer Name and Ticker or Trading Symbol
Renalytix plc [ RNLX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Ordinary Shares 9,956,874 D(1)(2)
American Depositary Shares 2,331,239(3) D(2)(4)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Options (Right to Buy) (5) 11/01/2028 Ordinary Shares 204,501 1.54(6) D(1)
1. Name and Address of Reporting Person*
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

(Last) (First) (Middle)
1 GUSTAVE L. LEVY PLACE

(Street)
NEW YORK NY 10029

(City) (State) (Zip)
1. Name and Address of Reporting Person*
MOUNT SINAI HOSPITAL

(Last) (First) (Middle)
1 GUSTAVE L. LEVY PLACE

(Street)
NEW YORK NY 10029

(City) (State) (Zip)
1. Name and Address of Reporting Person*
MOUNT SINAI HEALTH SYSTEM, INC.

(Last) (First) (Middle)
150 EAST 42ND STREET
SUITE 2-B.17

(Street)
NEW YORK NY 10017

(City) (State) (Zip)
1. Name and Address of Reporting Person*
MOUNT SINAI HOSPITALS GROUP, INC.

(Last) (First) (Middle)
1 GUSTAVE L. LEVY PLACE

(Street)
NEW YORK NY 10029

(City) (State) (Zip)
Explanation of Responses:
1. The securities reported herein are held directly by Icahn School of Medicine at Mount Sinai ("ISMMS").
2. As the sole member of The Mount Sinai Hospital ("MSH"), Mount Sinai Hospitals Group, Inc. ("MSHG") may be deemed to beneficially own the securities held by MSH. As the sole member of MSHG, Mount Sinai Health System, Inc. ("MSHS") may be deemed to beneficially own the securities beneficially owned by MSHG. As the sole member of ISMMS, MSHS may be deemed to beneficially own the securities held by ISMMS. Each of the reporting persons disclaims beneficial ownership of all such securities reported herein, except to the extent of its pecuniary interest, if any.
3. Each American Depositary Share of the Issuer represents two Ordinary Shares of the Issuer.
4. 948,750 American Depositary Shares are held directly by MSH and 1,382,489 American Depositary Shares are held directly by ISMMS.
5. These stock options are fully vested.
6. The exercise price was converted from GBP1.21, based on an exchange rate of USD1.27 to GBP1.00.
Remarks:
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI By: /s/ Stephen Harvey, Name: Stephen Harvey, Chief Financial Officer 07/03/2023
THE MOUNT SINAI HOSPITAL By: /s/ Stephen Harvey, Name: Stephen Harvey, Chief Financial Officer 07/03/2023
MOUNT SINAI HEALTH SYSTEM, INC. By: /s/ Stephen Harvey, Name: Stephen Harvey, Chief Financial Officer 07/03/2023
MOUNT SINAI HOSPITALS GROUP, INC. By: /s/ Stephen Harvey, Name: Stephen Harvey, Chief Financial Officer 07/03/2023
** 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 5 (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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