0001213900-21-058626.txt : 20211112
0001213900-21-058626.hdr.sgml : 20211112
20211112153830
ACCESSION NUMBER: 0001213900-21-058626
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211110
FILED AS OF DATE: 20211112
DATE AS OF CHANGE: 20211112
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Vajdic Branislav
CENTRAL INDEX KEY: 0001422425
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41060
FILM NUMBER: 211403007
MAIL ADDRESS:
STREET 1: 2033 GATEWAY PLAZA, SUITE 500
CITY: SAN JOSE
STATE: CA
ZIP: 95110
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: HeartBeam, Inc.
CENTRAL INDEX KEY: 0001779372
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 474881450
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2118 WALSH AVE., SUITE 210
CITY: SANTA CLARA
STATE: CA
ZIP: 95050
BUSINESS PHONE: 408-899-4443
MAIL ADDRESS:
STREET 1: 2118 WALSH AVE., SUITE 210
CITY: SANTA CLARA
STATE: CA
ZIP: 95050
3
1
ownership.xml
X0206
3
2021-11-10
0
0001779372
HeartBeam, Inc.
BEAT
0001422425
Vajdic Branislav
2118 WALSH AVE, SUITE 210
SANTA CLARA
CA
95050
0
1
1
0
Chief Executive Officer
Common Stock
794545
D
Convertible Promissory Note
Common Stock
115559
D
Common Stock warrant (right to buy)
2.75
2023-02-11
Common Stock
5818
D
Common Stock warrant (right to buy)
0.0003
2023-02-12
Common Stock
363636
D
32,727 shares are held in the name of his spouse, Marijana Rakic.
Represents $485,347.80 of outstanding principal and interest calculated through November 10, 2021. The note will convert into 115,559 shares of Common Stock upon the closing of the Issuer's initial public offering of Common Stock (the "IPO").
All of the shares subject to the warrant are fully vested and exercisable as of the date hereof.
The shares subject to the warrant are exercisable upon the earliest to occur of several events, including the closing of the IPO and the Issuer having a market capitalization of at least $50,000,000 for five consecutive business days.
/s/ Branislav Vajdic
2021-11-10