Allan R. Will - 30 Sep 2024 Form 3/A - Amendment Insider Report for EBR Systems, Inc. (EBRCZ)

Reporting relationship: Director
Issuer ticker: EBRCZ
Reported as of: 30 Sep 2024
Net transaction value: $0
SEC form: 3/A - Amendment
Accepted by SEC: 22 May 2025, 20:34:37 UTC
Original report date: 30 Sep 2024
Prior SEC filing: 01 Feb 2024
Next SEC filing: 02 Jan 2025
Source filing: View source filing
Reporting owner signature: /s/ Gary W Doherty, Attorney-in-Fact

Key filing fact

Allan R. Will filed Form 3/A - Amendment for EBR Systems, Inc. (EBRCZ) on 22 May 2025.

Key facts

This page summarizes Allan R. Will's Form 3/A - Amendment filing for EBR Systems, Inc. (EBRCZ).
0 reported transactions and 10 derivative rows are listed below.
Accepted by SEC: 22 May 2025, 20:34.

Change

Previous filing in this sequence was filed on 01 Feb 2024.
Current net transaction value: $0.

Research use

This tells you what this filing adds before you inspect full transaction and derivative tables.
You can trace every row back to the original SEC filing document.

Evidence

Official SEC source

Ownership activity is grounded in SEC Form 3/A - Amendment disclosures.

View source filing

Reporting Owners (1)

CIK 0001367902 Primary reporting owner

Will Allan R

Relationship: Director
Address: 480 OAKMEAD PARKWAY, SUNNYVALE
Signature: /s/ Gary W Doherty, Attorney-in-Fact
Signature date: 22 May 2025

Reported non-derivative transactions

Shares, units, or other non-derivative securities reported in this filing.

EBRCZ holding

Common Stock

No transaction description listed

Transaction value
Shares
Change %
Price
Shares after: 5,827,224
Date: 30 Sep 2024
Ownership: By the Allan R. Will Trust U/A Dtd 6/14/2012
Footnotes: F1

EBRCZ holding

Common Stock

No transaction description listed

Transaction value
Shares
Change %
Price
Shares after: 600,000
Date: 30 Sep 2024
Ownership: By Taphne Ann Lux
Footnotes: F1, F2, F3

Reported derivative securities

Options, warrants, convertible securities, or similar derivative positions disclosed in the filing.

EBRCZ holding Derivative

Stock Option (right to buy)

No transaction description listed

Transaction value
Shares
Change %
Price
Shares after
Date: 30 Sep 2024
Ownership: Direct
Underlying class: Common Stock
Underlying amount: 2,305,564
Exercise price: $0.1400
Footnotes: F4

EBRCZ holding Derivative

Stock Option (right to buy)

No transaction description listed

Transaction value
Shares
Change %
Price
Shares after
Date: 30 Sep 2024
Ownership: Direct
Underlying class: Common Stock
Underlying amount: 58,500
Exercise price: $0.1600
Footnotes: F4

EBRCZ holding Derivative

Stock Option (right to buy)

No transaction description listed

Transaction value
Shares
Change %
Price
Shares after
Date: 30 Sep 2024
Ownership: Direct
Underlying class: Common Stock
Underlying amount: 171,121
Exercise price: $0.7992
Footnotes: F5

EBRCZ holding Derivative

Stock Option (right to buy)

No transaction description listed

Transaction value
Shares
Change %
Price
Shares after
Date: 30 Sep 2024
Ownership: Direct
Underlying class: Common Stock
Underlying amount: 182,159
Exercise price: $0.4400
Footnotes: F6

EBRCZ holding Derivative

Stock Option (right to buy)

No transaction description listed

Transaction value
Shares
Change %
Price
Shares after
Date: 30 Sep 2024
Ownership: Direct
Underlying class: Common Stock
Underlying amount: 163,637
Exercise price: $0.5500
Footnotes: F7

EBRCZ holding Derivative

Warrant (right to buy)

No transaction description listed

Transaction value
Shares
Change %
Price
Shares after
Date: 30 Sep 2024
Ownership: By the Allan R. Will Trust U/A Dtd 6/14/2012
Underlying class: Common Stock
Underlying amount: 63,820
Exercise price: $0.5891

EBRCZ holding Derivative

Warrant (right to buy)

No transaction description listed

Transaction value
Shares
Change %
Price
Shares after
Date: 30 Sep 2024
Ownership: By the Allan R. Will Trust U/A Dtd 6/14/2012
Underlying class: Common Stock
Underlying amount: 63,820
Exercise price: $0.5891

EBRCZ holding Derivative

Warrant (right to buy)

No transaction description listed

Transaction value
Shares
Change %
Price
Shares after
Date: 30 Sep 2024
Ownership: By the Allan R. Will Trust U/A Dtd 6/14/2012
Underlying class: Common Stock
Underlying amount: 25,528
Exercise price: $0.5891

EBRCZ holding Derivative

Warrant (right to buy)

No transaction description listed

Transaction value
Shares
Change %
Price
Shares after
Date: 30 Sep 2024
Ownership: By the Allan R. Will Trust U/A Dtd 6/14/2012
Underlying class: Common Stock
Underlying amount: 48,422
Exercise price: $0.5891

EBRCZ holding Derivative

Warrant (right to buy)

No transaction description listed

Transaction value
Shares
Change %
Price
Shares after
Date: 30 Sep 2024
Ownership: By the Allan R. Will Trust U/A Dtd 6/14/2012
Underlying class: Common Stock
Underlying amount: 48,422
Exercise price: $0.5891

^* marks a reported price that did not pass the local price check.

Additional SEC filing notes

Filing notes and footnotes

Explanation of responses 7 footnotes

Footnote F1

Represents shares of the Issuer's common stock underlying the same amount of Chess Depositary Interests ("CDIs"). The CDIs are traded on the Australian Securities Exchange (the "ASX") and are held by CHESS Depositary Nominees Pty, Limited, a subsidiary of ASX Limited, the company that operates the ASX.

Footnote F2

On September 30, 2024, the reporting person mistakenly filed a Form 3 reporting the indirect ownership of 628,000 shares of common stock. After further analysis, it was determined that Mr. Will does have 600,000 shares of indirect beneficial ownership of the Issuer's common stock held by Taphne Ann Lux and underlying the same amount of CDIs.

Footnote F3

Family Member

Footnote F4

Fully Vested.

Footnote F5

1/3 of the shares subject to the stock option vest on the one-year anniversary as measured from 10/1/2021, and the remainder of the shares vest in 24 equal monthly installments thereafter, subject to continued employment or service through each such date. If applicable, vesting accelerates as provided in, and subject to the terms and conditions of, that certain Severance and Change of Control Agreement between the Issuer and the Reporting Person, as may be amended from time to time.

Footnote F6

1/12 of the Option vests in equal monthly installments as measured from 5/22/2023, subject to continued employment or service through each such date. If applicable, vesting accelerates as provided in, and subject to the terms and conditions of, that certain Severance and Change of Control Agreement between the Issuer and the Reporting Person, as may be amended from time to time.

Footnote F7

1/12 of the Option vests in equal monthly installments as measured from 5/29/2024, subject to continued employment or service through each such date. If applicable, vesting accelerates as provided in, and subject to the terms and conditions of, that certain Severance and Change of Control Agreement between the Issuer and the Reporting Person, as may be amended from time to time.

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