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*
Filloux Dominique J.

(Last) (First) (Middle)
C/O MINERVA SURGICAL, INC.
4255 BURTON DRIVE

(Street)
SANTA CLARA CA 95054

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/21/2021
3. Issuer Name and Ticker or Trading Symbol
MINERVA SURGICAL INC [ UTRS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
COO
5. 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 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)
Common Stock 181,591(1) D
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 Option (Right to Buy) (2) 06/16/2031 Common Stock 48,130 13.12 D
Explanation of Responses:
1. 24,522 Shares were acquired pursuant to the exercise of an early-exercise option and remain subject to a right of repurchase by the Company, which shall lapse with respect to one-forty-eighth of the shares on June 10, 2019 and with respect to one-forty-eighth of the remaining shares each month thereafter. 64,505 Shares were acquired pursuant to the exercise of an early-exercise option and remain subject to a right of repurchase by the Company, which shall lapse with respect to one-forty-eighth of the shares on April 1, 2021 and with respect to one-forty-eighth of the remaining shares each month thereafter.
2. One-half of the shares subject to the option vested on June 16, 2021 and one-twenty-fourth of the remaining shares vest on each month thereafter, subject to the Reporting Person continuing as a service provider through each such date.
Remarks:
Exhibit 24 - Power of Attorney
Lenka Schvaigerova, Attorney-in-fact for Dominique J. Filloux 10/21/2021
** 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 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).
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.
                                POWER OF ATTORNEY

      The undersigned, as a Section 16 reporting person of Minerva Surgical,
Inc.
(the "Company"), hereby constitutes and appoints Joanne Long, Joel Jung,
Jon Wangsness, Lenka Schvaigerova, and Joan Moses the undersigned's true and
lawful attorneys-in-fact to:

	1.  complete and execute Forms 3, 4 and 5 and other forms and all
amendments thereto as such attorneys-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; and

	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 attorneys-in-fact shall deem
appropriate.

      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 October 16, 2021.


      					/s/Dominique J. Filloux
					Dominique J. Filloux