0001779372-24-000015.txt : 20240620 0001779372-24-000015.hdr.sgml : 20240620 20240620165041 ACCESSION NUMBER: 0001779372-24-000015 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240612 FILED AS OF DATE: 20240620 DATE AS OF CHANGE: 20240620 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Elfrink Willem CENTRAL INDEX KEY: 0001893194 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41060 FILM NUMBER: 241057187 MAIL ADDRESS: STREET 1: 2118 WALSH AVE STREET 2: SUITE 210 CITY: SANTA CLARA STATE: CA ZIP: 95050 FORMER NAME: FORMER CONFORMED NAME: Elfrink Willhem DATE OF NAME CHANGE: 20211110 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HeartBeam, Inc. CENTRAL INDEX KEY: 0001779372 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] ORGANIZATION NAME: 08 Industrial Applications and Services 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 4 1 wk-form4_1718916634.xml FORM 4 X0508 4 2024-06-12 0 0001779372 HeartBeam, Inc. BEAT 0001893194 Elfrink Willem 2118 WALSH AVE, SUITE 210 SANTA CLARA CA 95050 1 0 0 0 0 Common Stock 2024-06-12 4 A 0 33185 0 A 317982 D Common Stock 106825 I See Footnote Common Stock (right to buy) 2.50 2031-06-15 Common Stock 43636 43636 D Warrant (right to buy) 6 2021-12-21 2026-11-11 Common Stock 10000 10000 D Warrant (right to buy) 6 2022-06-16 2026-11-11 Common Stock 50000 50000 D These securities are restricted stock units (RSUs). Each RSU represents a contingent right to receive one share of Common Stock of the Issuer. 100% of the RSUs shall vest on the earlier of June 12, 2025, or the date of the Issuer's 2025 annual meeting of stockholders, subject to the Reporting Person continuing to be an Outside Director (as defined in the Issuer's 2022 Equity Inventive Plan) through the applicable vesting date. These shares are held by the Elfrink Living Trust, of which the Reporting Person is the trustee. One forty-eighth of the shares subject to the option vest on July 15, 2021 and each one-month anniversary thereafter, subject to the Reporting Person continuing as a service provider through each such date. /s/ Willem Elfrink 2024-06-20