Willem Elfrink - 10 Nov 2021 Form 3 Insider Report for HeartBeam, Inc. (BEAT)

Role
Director
Signature
/s/ Willem Elfrink
Issuer symbol
BEAT
Transactions as of
10 Nov 2021
Net transactions value
$0
Form type
3
Filing time
12 Nov 2021, 15:09:51 UTC
Next filing
15 Nov 2021
SEC
View on sec.gov

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
holding BEAT Common Stock 105,454 10 Nov 2021 Direct

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Underlying Class Amount Exercise Price Ownership Footnotes
holding BEAT Convertible Promissory Note 10 Nov 2021 Common Stock 60,972 Direct F1
holding BEAT Convertible Promissory Note 10 Nov 2021 Common Stock 106,825 See Footnote F2, F3
holding BEAT Convertible Promissory Note 10 Nov 2021 Common Stock 164,610 See Footnote F4, F5
holding BEAT Stock option (right to buy) 10 Nov 2021 Common Stock 43,636 $2.50 Direct F6
holding BEAT Common Stock warrant (right to buy) 10 Nov 2021 Common Stock 3,640 $2.75 Direct F7
holding BEAT Common Stock warrant (right to buy) 10 Nov 2021 Common Stock 43,636 $0.000300 Direct F8
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
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.