Sec Form 4 Filing - Simpson Andrew @ Heart Test Laboratories, Inc. - 2023-03-20

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Simpson Andrew
2. Issuer Name and Ticker or Trading Symbol
Heart Test Laboratories, Inc. [ HSCS]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
See Remarks
(Last) (First) (Middle)
C/O HEART TEST LABORATORIES, INC.,, 550 RESERVE STREET, SUITE 360
3. Date of Earliest Transaction (MM/DD/YY)
03/20/2023
(Street)
SOUTHLAKE, TX76092
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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
Employee Stock Option (Right to Buy) $ 0.97 ( 1 ) 03/20/2023 A 300,000 ( 2 ) 03/20/2033( 3 ) Common Stock 300,000 ( 1 ) 300,000 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Simpson Andrew
C/O HEART TEST LABORATORIES, INC.,
550 RESERVE STREET, SUITE 360
SOUTHLAKE, TX76092
X See Remarks
Signatures
/s/ Andrew Simpson 03/22/2023
Signature of Reporting Person Date
Explanation of Responses:
( 1 )These options were granted to the Reporting Person effective as of March 20, 2023 (the "Effective Date"), pursuant to the approval of the Issuer's board of directors on March 20, 2023.
( 2 )One-third of the options shall vest on the 12-month anniversary of the Effective Date, with an additional 8.333% of the options vesting on each of June 20, 2024 (the "Subsequent Vesting Date") and thereafter on each successive three-month anniversary of the Subsequent Vesting Date for the next seven fiscal quarters, subject to the Reporting Person's continued employment with the Issuer through each applicable vesting date and subject to the terms of the Issuer's 2023 Equity Incentive Plan (the "2023 Plan"). These options shall become fully-vested and may be exercised at any time at the Reporting Person's election upon the Issuer receiving regulatory clearance for its MyoVista wavECG device (or similar such product owned by the Issuer) from the U.S. Food and Drug Administration. As of the date of this filing, such regulatory clearance has not been received.
( 3 )These options expire ten years from the Effective Date, unless terminated sooner in accordance with the 2023 Plan or the underlying options grant agreement.

Remarks:
Chairman of the Board, President and Chief Executive Officer

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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