0001209191-21-036233.txt : 20210527 0001209191-21-036233.hdr.sgml : 20210527 20210527161112 ACCESSION NUMBER: 0001209191-21-036233 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210525 FILED AS OF DATE: 20210527 DATE AS OF CHANGE: 20210527 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: 001-38445 FILM NUMBER: 21972785 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: 364787690 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 642 NEWTOWN YARDLEY ROAD CITY: NEWTOWN STATE: PA ZIP: 18940 BUSINESS PHONE: 215-944-6104 MAIL ADDRESS: STREET 1: 642 NEWTOWN YARDLEY ROAD CITY: NEWTOWN STATE: PA ZIP: 18940 FORMER COMPANY: FORMER CONFORMED NAME: HELIUS MEDICAL TECHNOLOGIES, INC DATE OF NAME CHANGE: 20180517 FORMER COMPANY: FORMER CONFORMED NAME: HELIUS MEDICAL TECHNOLOGIES, INC. DATE OF NAME CHANGE: 20140613 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-05-25 0 0001610853 HELIUS MEDICAL TECHNOLOGIES, INC. HSDT 0001201810 ANDREEFF DANE C/O HELIUS MEDICAL TECHNOLOGIES INC. 642 NEWTOWN YARDLEY ROAD SUITE 100 NEWTOWN PA 18940 1 1 0 0 Interim President and CEO Class A Common Stock 2021-05-25 4 A 0 937 0.00 A 1508 D Class A Common Stock 47054 I See footnote Class A Common Stock 11498 I See footnote Class A Common Stock 29009 I See footnote Class A Common Stock 3484 I See footnote Stock Option (Right to Buy) 13.30 2021-05-25 4 A 0 3063 0.00 A 2031-05-24 Class A Common Stock 3063 3063 D Grant to the Reporting Person of restricted stock units ("RSUs") under the Issuer's 2018 Omnibus Incentive Plan. The RSUs vest in a series of twelve (12) successive equal monthly installments on the last day of each month so that all of the RSUs will be vested on the one-year anniversary of the grant date, subject to the Reporting Person's continued service through each applicable vesting period. 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. The shares are held by Maple Leaf Offshore Ltd. ("MLO"). The reporting person is the president of the managing member of Andreeff Equity Advisors, L.L.C., the investment manager of MLO and as such may be deemed to beneficially own the securities held by MLO. 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. Grant to the Reporting Person of a stock option under the Issuer's 2018 Omnibus Incentive Plan. The options vest in a series of twelve (12) successive equal monthly installments on the last day of each month so that all of the options will be vested on the one-year anniversary of the grant date, subject to the Reporting Person's continued service through each applicable vesting period. /s/ Dane C. Andreeff 2021-05-27