Amended Statement of Changes in Beneficial Ownership (4/a)
29 Junho 2023 - 5:12PM
Edgar (US Regulatory)
FORM 4
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB Number:
3235-0287
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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
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ElBardissi Andrew |
2. Issuer Name and Ticker or Trading Symbol
Acutus Medical, Inc.
[
AFIB
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O ACUTUS MEDICAL, INC., 2210 FARADAY AVE., SUITE 100 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/15/2023 |
(Street)
CARLSBAD, CA 92008 |
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
6/15/2023 |
6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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(City)
(State)
(Zip)
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Rule 10b5-1(c) Transaction Indication
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Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan that is intended to
satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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FORM 4 (1) | 6/15/2023 | | A | | 8400 (2) | A | $0 | 20822 | D (3) | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
FORM 4 (4) | $0.8349 | 6/15/2023 | | A | | 19600 (5) | | 6/15/2024 | 6/15/2033 | FORM 4 (1) | 19600.0 | $0 | 19600 | D (3) | |
Explanation of Responses: |
(1) | Common Stock |
(2) | Each annual restricted stock unit ("Annual RSU") will be scheduled to vest as to all of the Shares of Common Stock ("Shares) subject to such Annual RSU on the first anniversary of the date of grant of such Annual RSU, if on such date the Reporting Person has remained in continuous service as a director. |
(3) | The Reporting Person, a partner in Deerfield Management Company, L.P., holds the securities reported herein (and has held since the date of their respective issuances all securities of the Issuer previously reported in statements of changes in beneficial ownership filed by Reporting Person in respect of the Issuer) for the benefit, and at the direction, of Deerfield Management Company, L.P. Accordingly, the Reporting Person disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein, if any. |
(4) | Stock Options (Right to Buy) |
(5) | Each annual stock option ("the Annual Option") will be scheduled to vest and become exercisable as to all of the Shares subject to such Annual Option on the first anniversary of the date of grant of such Annual Option, if on such date the Reporting Person has remained in continuous service as director. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
ElBardissi Andrew C/O ACUTUS MEDICAL, INC. 2210 FARADAY AVE., SUITE 100 CARLSBAD, CA 92008 | X |
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Signatures
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Tom Sohn Attorney-in-fact | | 6/29/2023 |
**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 4(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 control number. |
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