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