SEC FORM 4

SEC Form 4

FORM 4

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

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

1. Name and Address of Reporting Person^*

LaViscount Joyce N

(Last)

(First)

(Middle)

C/O HELIUS MEDICAL TECHNOLOGIES, INC.

642 NEWTOWN YARDLEY ROAD, SUITE 100

(Street)

NEWTOWN

18940

(City)

(State)

(Zip)

2. Issuer Name and Ticker or Trading Symbol
HELIUS MEDICAL TECHNOLOGIES, INC. [ HSDT ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
	CFO and COO

3. Date of Earliest Transaction (Month/Day/Year)
12/07/2019

4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	3. Transaction Code (Instr. 8)		4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5)			5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)	6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	4. Transaction Code (Instr. 8)		5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)		6. Date Exercisable and Expiration Date (Month/Day/Year)		7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)		8. Price of Derivative Security (Instr. 5)	9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)	10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	8. Price of Derivative Security (Instr. 5)		10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
Employee Stock Option (Right to Buy)	$12.52	12/07/2019		D⁽¹⁾			20,000	⁽²⁾	03/16/2020	Class A Common Stock	20,000	$0.00	0	D
Employee Stock Option (Right to Buy)	$12.52	12/07/2019		A⁽¹⁾		20,000		⁽²⁾	03/16/2025	Class A Common Stock	20,000	$0.00	20,000	D
Employee Stock Option (Right to Buy)	$3.2	12/07/2019		D⁽³⁾			150,000	⁽²⁾	10/21/2020	Class A Common Stock	150,000	$0.00	0	D
Employee Stock Option (Right to Buy)	$3.2	12/07/2019		A⁽³⁾		150,000		⁽²⁾	10/21/2025	Class A Common Stock	150,000	$0.00	150,000	D
Employee Stock Option (Right to Buy)	$5.35	12/07/2019		D⁽⁴⁾			120,000	⁽²⁾	07/13/2020	Class A Common Stock	120,000	$0.00	0	D
Employee Stock Option (Right to Buy)	$5.35	12/07/2019		A⁽⁴⁾		120,000		⁽²⁾	07/13/2026	Class A Common Stock	120,000	$0.00	120,000	D

Explanation of Responses:

1. These two reported transactions involved an amendment of an outstanding option originally granted on March 16, 2015 resulting in the deemed cancellation of the March 16, 2015 option and the grant of a replacement option with the same terms other than the expiration date.

2. Immediately exercisable.

3. These two reported transactions involved an amendment of an outstanding option originally granted on October 21, 2015 resulting in the deemed cancellation of the October 21, 2015 option and the grant of a replacement option with the same terms other than the expiration date.

4. These two reported transactions involved an amendment of an outstanding option originally granted on July 13, 2016 resulting in the deemed cancellation of the July 13, 2016 option and the grant of a replacement option with the same terms other than the expiration date.

Remarks:

Effective January 22, 2018, the Issuer effected a 1-for-5 reverse stock split of the Issuer's Class A Common Stock. All share numbers herein give effect to the reverse stock split. In addition, all conversion or exercise prices of derivative securities in column 2 of Table II herein are translated into U.S. Dollars from Canadian dollars.

	/s/ Joyce LaViscount	12/16/2019
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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