0001437749-21-027829.txt : 20211203
0001437749-21-027829.hdr.sgml : 20211203
20211203160805
ACCESSION NUMBER: 0001437749-21-027829
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211201
FILED AS OF DATE: 20211203
DATE AS OF CHANGE: 20211203
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Erickson Stan K.
CENTRAL INDEX KEY: 0001626702
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-34839
FILM NUMBER: 211470049
MAIL ADDRESS:
STREET 1: 10380 28TH AVENUE NORTH
CITY: MINNEAPOLIS
STATE: MN
ZIP: 55441
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Electromed, Inc.
CENTRAL INDEX KEY: 0001488917
STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845]
IRS NUMBER: 411732920
FISCAL YEAR END: 0630
BUSINESS ADDRESS:
STREET 1: 500 SIXTH AVENUE NW
CITY: NEW PRAGUE
STATE: MN
ZIP: 56071
BUSINESS PHONE: 952-758-9299
MAIL ADDRESS:
STREET 1: 500 SIXTH AVENUE NW
CITY: NEW PRAGUE
STATE: MN
ZIP: 56071
4
1
rdgdoc.xml
FORM 4
X0306
4
2021-12-01
0001488917
Electromed, Inc.
ELMD
0001626702
Erickson Stan K.
500 SIXTH AVENUE NW
NEW PRAGUE
MN
56071
1
Common Stock
2021-12-01
4
A
0
3000
0
A
26817
D
Common Stock
1500
I
By Liberty Capital, LP
Restricted Stock scheduled to vest on June 1, 2022, unless earlier accelerated or terminated pursuant to their terms.
The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose.
/s/ Joshua L. Colburn, Attorney-in-Fact
2021-12-03