0001104659-22-100061.txt : 20220914 0001104659-22-100061.hdr.sgml : 20220914 20220914164517 ACCESSION NUMBER: 0001104659-22-100061 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220913 FILED AS OF DATE: 20220914 DATE AS OF CHANGE: 20220914 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Favit-Van Pelt Antonella R. CENTRAL INDEX KEY: 0001871533 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38445 FILM NUMBER: 221243485 MAIL ADDRESS: STREET 1: C/O HELIUS MEDICAL TECHNOLOGIES, INC. STREET 2: 642 NEWTOWN YARDLEY ROAD CITY: NEWTOWN STATE: PA ZIP: 18940 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HELIUS MEDICAL TECHNOLOGIES, INC. CENTRAL INDEX KEY: 0001610853 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 364787690 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 642 NEWTOWN YARDLEY ROAD CITY: NEWTOWN STATE: PA ZIP: 18940 BUSINESS PHONE: 215-944-6104 MAIL ADDRESS: STREET 1: 642 NEWTOWN YARDLEY ROAD CITY: NEWTOWN STATE: PA ZIP: 18940 FORMER COMPANY: FORMER CONFORMED NAME: HELIUS MEDICAL TECHNOLOGIES, INC DATE OF NAME CHANGE: 20180517 FORMER COMPANY: FORMER CONFORMED NAME: HELIUS MEDICAL TECHNOLOGIES, INC. DATE OF NAME CHANGE: 20140613 4 1 tm2225892-2_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2022-09-13 0 0001610853 HELIUS MEDICAL TECHNOLOGIES, INC. HSDT 0001871533 Favit-Van Pelt Antonella R. C/O HELIUS MEDICAL TECHNOLOGIES, INC. 642 NEWTOWN YARDLEY ROAD, SUITE 100 NEWTOWN PA 18940 0 1 0 0 Chief Medical Officer Stock Option (Right to Buy) 0.54 2022-09-13 4 A 0 10000 0 A 2032-09-12 Common Stock 10000 10000 D Grant to the Reporting Person of a stock option under the Issuer's 2022 Equity Incentive Plan. The options vest in a series of twelve (12) successive equal quarterly installments on the last day of each quarter so that all of the options will be vested on the three-year anniversary of the grant date, subject to the Reporting Person's continued service through each applicable vesting period. /s/ Emily Johns, by Power of Attorney 2022-09-14