SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
DALTON NATHANIEL

(Last) (First) (Middle)
C/O ICAD, INC.
98 SPIT BROOK ROAD, SUITE 100

(Street)
NASHUA NH 03062

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/12/2020
3. Issuer Name and Ticker or Trading Symbol
ICAD INC [ ICAD ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 72,727 I As co-manager of Daybreak Investments LLC
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (1) 09/10/2024 Common Stock 2,000 $6.54 D
Convertible Debentures 12/21/2018 12/21/2021 Common Stock 100,000 $4 I As co-manager of Daybreak Investments LLC
Explanation of Responses:
1. The Reporting Person was granted an option to purchase 4,000 shares on September 9, 2019. 25% of the option vested on the date of grant, with the remainder vesting in three quarterly increments over a nine month period, as long as the Consulting Agreement, dated as of September 10, 2019, between the Company and the Reporting Person (the "Consulting Agreement") continues to be in effect. The Consulting Agreement was terminated effective December 31, 2019.
Remarks:
/s/ Nathaniel Dalton 01/14/2020
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.