0001209191-17-067259.txt : 20171226 0001209191-17-067259.hdr.sgml : 20171225 20171226173056 ACCESSION NUMBER: 0001209191-17-067259 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171222 FILED AS OF DATE: 20171226 DATE AS OF CHANGE: 20171226 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ANDREEFF DANE CENTRAL INDEX KEY: 0001201810 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-55364 FILM NUMBER: 171274969 MAIL ADDRESS: STREET 1: C/O ANDREEFF EQUITY ADVISORS L.L.C. STREET 2: 140 E. ST. LUCIA LANE CITY: SANTA ROSA BEACH STATE: FL ZIP: 32459 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HELIUS MEDICAL TECHNOLOGIES, INC. CENTRAL INDEX KEY: 0001610853 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 000000000 STATE OF INCORPORATION: WY FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: SUITE 400, 41 UNIVERSITY DRIVE CITY: NEWTOWN STATE: PA ZIP: 18940 BUSINESS PHONE: 215-809-2018 MAIL ADDRESS: STREET 1: SUITE 400, 41 UNIVERSITY DRIVE CITY: NEWTOWN STATE: PA ZIP: 18940 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-12-22 0 0001610853 HELIUS MEDICAL TECHNOLOGIES, INC. HSDT 0001201810 ANDREEFF DANE 642 NEWTOWN YARDLEY ROAD, SUITE 100 NEWTOWN PA 18940 1 0 0 0 Class A Common Stock 2017-12-22 4 P 0 141027 1.96 A 1485796 I See footnote Class A Common Stock 2017-12-22 4 P 0 30927 1.96 A 325338 I See footnote Class A Common Stock 2017-12-22 4 P 0 83147 1.96 A 789435 I See footnote Warrant (Right to Buy) 2.45 2017-12-22 4 P 0 141027 1.96 A 2020-12-22 Class A Common Stock 141027 141027 I See footnote Warrant (Right to Buy) 2.45 2017-12-22 4 P 0 30927 1.96 A 2020-12-22 Class A Common Stock 30927 30927 I See footnote Warrant (Right to Buy) 2.45 2017-12-22 4 P 0 83147 1.96 A 2020-12-22 Class A Common Stock 83147 83147 I See footnote The Class A Common Stock and the Warrant to Purchase Class A Common Stock was purchased by the Reporting Person in a private placement as a Unit. The purchase price of the Unit was $1.96. The shares are held by Maple Leaf Partners, L.P. ("MLP"). The reporting person is the managing member of Maple Leaf Capital I, LLC ("Maple Leaf Capital"), the general partner of MLP, and as such may be deemed to beneficially own the securities owned by MLP. The reporting person disclaims beneficial ownership over such shares except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of the reported shares for purposes of Section 16 or for any other purposes. The shares are held by Maple Leaf Partners I, L.P. ("MLP I"). The reporting person is the managing member of Maple Leaf Capital, the general partner of MLP I, and as such may be deemed to beneficially own the securities held by MLP I. The reporting person disclaims beneficial ownership over such shares except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of the reported shares for purposes of Section 16 or for any other purposes. The shares are held by Maple Leaf Discovery I, L.P. ("MLD I"). The reporting person is the managing member of Maple Leaf Capital, the general partner of MLD I, and as such may be deemed to beneficially own the securities held by MLD I. The reporting person disclaims beneficial ownership over such shares except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of the reported shares for purposes of Section 16 or for any other purposes. Immediately exercisable. /S/ Dane Andreeff 2017-12-26