0001213900-21-059714.txt : 20211115 0001213900-21-059714.hdr.sgml : 20211115 20211115215835 ACCESSION NUMBER: 0001213900-21-059714 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211111 FILED AS OF DATE: 20211115 DATE AS OF CHANGE: 20211115 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FERRARI RICHARD M CENTRAL INDEX KEY: 0001034413 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41060 FILM NUMBER: 211413921 MAIL ADDRESS: STREET 1: 10600 NORTH TANTAU AVENUE CITY: CUPERTINO STATE: CA ZIP: 95014 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 4 1 ownership.xml X0306 4 2021-11-11 0 0001779372 HeartBeam, Inc. BEAT 0001034413 FERRARI RICHARD M C/O HEARTBEAM, INC., 2118 WALSH AVENUE, SUITE 210 SANTA CLARA, CA 95050 1 0 0 0 Common Stock 2021-11-11 4 M 0 65653 4.20 A 65653 I See Footnote Represents shares purchased from conversion of convertible note, principal and interest of $275,743. The underlying common stock is held by the Ferrari Living Trust, of which the Reporting Person is the trustee. /s/ Richard Ferrari 2021-11-15