0001209191-19-060778.txt : 20191216 0001209191-19-060778.hdr.sgml : 20191216 20191216195848 ACCESSION NUMBER: 0001209191-19-060778 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191207 FILED AS OF DATE: 20191216 DATE AS OF CHANGE: 20191216 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GRIFFIN THOMAS E CENTRAL INDEX KEY: 0001625114 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38445 FILM NUMBER: 191288401 MAIL ADDRESS: STREET 1: C/O ENTELLUS MEDICAL, INC. STREET 2: 3600 HOLLY LANE NORTH, SUITE 40 CITY: PLYMOUTH STATE: MN ZIP: 55447 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HELIUS MEDICAL TECHNOLOGIES, INC. CENTRAL INDEX KEY: 0001610853 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 364787690 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 2019-12-07 0 0001610853 HELIUS MEDICAL TECHNOLOGIES, INC. HSDT 0001625114 GRIFFIN THOMAS E C/O HELIUS MEDICAL TECHNOLOGIES, INC. 642 NEWTOWN YARDLEY ROAD, SUITE 100 NEWTOWN PA 18940 1 0 0 0 Stock Option (Right to Buy) 4.98 2019-12-07 4 D 0 20000 0.00 D 2020-08-08 Class A Common Stock 20000 0 D Stock Option (Right to Buy) 4.98 2019-12-07 4 A 0 20000 0.00 A 2026-08-08 Class A Common Stock 20000 20000 D These two reported transactions involved an amendment of an outstanding option originally granted on August 8, 2016 resulting in the deemed cancellation of the August 8, 2016 option and the grant of a replacement option with the same terms other than the expiration date. Immediately exercisable. Effective January 22, 2018, the Issuer effected a 1-for-5 reverse stock split of the Issuer's Class A Common Stock. All share numbers herein give effect to the reverse stock split. In addition, all conversion or exercise prices of derivative securities in column 2 of Table II herein are translated into U.S. Dollars from Canadian dollars. /s/ Thomas E. Griffin 2019-12-16