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HeartBeam, Inc. Director's Dealing 2021

Nov 12, 2021

34512_dirs_2021-11-12_1fd741b2-8d5f-4c5d-bae5-e31fbac8241d.zip

Director's Dealing

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SEC Form 3 — Initial Statement of Beneficial Ownership

Issuer: HeartBeam, Inc. (BEAT)
CIK: 0001779372
Period of Report: 2021-11-10

Reporting Person: Elfrink Willhem (Director)

Holdings (Non-Derivative)

Security Shares Ownership
Common Stock 105454 Direct

Holdings (Derivative)

Security Exercise Price Expiration Underlying Shares Ownership
Convertible Promissory Note $ Common Stock (60972) Direct
Convertible Promissory Note $ Common Stock (106825) Indirect
Convertible Promissory Note $ Common Stock (164610) Indirect
Stock option (right to buy) $2.50 2031-06-15 Common Stock (43636) Direct
Common Stock warrant (right to buy) $2.75 2023-02-11 Common Stock (3640) Direct
Common Stock warrant (right to buy) $0.0003 2023-02-12 Common Stock (43636) Direct

Footnotes

F1: Represents $256,082.40 of outstanding principal and interest calculated through November 10, 2021. The note will convert into 60,972 shares of Common Stock upon the closing of the Issuer's initial public offering of Common Stock (the "IPO").

F2: Represents $448,665.00 of outstanding principal and interest calculated through November 10, 2021. The note will convert into 106,825 shares of Common Stock upon the closing of the IPO.

F3: The Convertible Promissory Note is held by the Elfrink Living Trust, of which the Reporting Person is the trustee.

F4: Represents $691,362.00 of outstanding principal and interest calculated through November 10, 2021. The note will convert into 164,610 shares of Common Stock upon the closing of the IPO.

F5: The Convertible Promissory Note is held by WPE Ventures Partnership, of which the Reporting Person is the managing partner.

F6: 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.

F7: All of the shares subject to the warrant are fully vested and exercisable as of the date hereof.

F8: 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.