0001213900-21-058857.txt : 20211112 0001213900-21-058857.hdr.sgml : 20211112 20211112201502 ACCESSION NUMBER: 0001213900-21-058857 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: Hunt Jon Patrick CENTRAL INDEX KEY: 0001893665 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41060 FILM NUMBER: 211405743 MAIL ADDRESS: STREET 1: 2118 WALSH AVE STREET 2: SUITE 210 CITY: SANTA CLARA STATE: CA ZIP: 95050 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 OWNERSHIP DOCUMENT X0206 3 2021-11-10 0 0001779372 HeartBeam, Inc. BEAT 0001893665 Hunt Jon Patrick 2118 WALSH AVE, SUITE 210 SANTA CLARA CA 95050 0 1 0 0 Chief Business Officer Convertible Promissory Note Common Stock 23976 I See Footnote Represents $100,699.20 of outstanding principal and interest calculated through November 10, 2021. The note will convert into 23,976 shares Common Stock upon the closing of the Issuer's initial public offering of Common Stock (the "IPO"). Convertible Promissory Note is held by the Jon P and Christine M Hunt. /s/ Jon Hunt 2021-11-10