SEC Filing | Acutus Medical, Inc.

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SEC FORM 4 SEC Form 4

FORM 4

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
or Section 30(h) of the Investment Company Act of 1940

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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).

1. Name and Address of Reporting Person^*

Malik Shahzad

(Last)

(First)

(Middle)

C/O ACUTUS MEDICAL, INC.

2210 FARADAY AVE., SUITE 100

(Street)

CARLSBAD

92008

(City)

(State)

(Zip)

2. Issuer Name and Ticker or Trading Symbol
Acutus Medical, Inc. [ AFIB ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
	Officer (give title below)	Other (specify below)

3. Date of Earliest Transaction (Month/Day/Year)
08/10/2020

4. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	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)
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
Common Stock	08/10/2020		C		65,436	A	$0	65,436	I	See footnote⁽¹⁾
Common Stock	08/10/2020		C		1,551,713	A	$0	1,551,713	I	See footnote⁽²⁾
Common Stock								2,222	D

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 (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	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 (Month/Day/Year)		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: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	8. Price of Derivative Security (Instr. 5)		10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
Series A Convertible Preferred Stock	$0	08/10/2020		C			10,738	⁽³⁾	⁽³⁾	Common Stock	10,738	$0	0	I	See footnote⁽¹⁾
Series A Convertible Preferred Stock	$0	08/10/2020		C			254,495	⁽³⁾	⁽³⁾	Common Stock	254,495	$0	0	I	See footnote⁽²⁾
Series B Convertible Preferred Stock	$0	08/10/2020		C			34,261	⁽³⁾	⁽³⁾	Common Stock	34,261	$0	0	I	See footnote⁽¹⁾
Series B Convertible Preferred Stock	$0	08/10/2020		C			812,683	⁽³⁾	⁽³⁾	Common Stock	812,683	$0	0	I	See footnote⁽²⁾
Series C Convertible Preferred Stock	$0	08/10/2020		C			13,195	⁽³⁾	⁽³⁾	Common Stock	13,195	$0	0	I	See footnote⁽¹⁾
Series C Convertible Preferred Stock	$0	08/10/2020		C			312,840	⁽³⁾	⁽³⁾	Common Stock	312,840	$0	0	I	See footnote⁽²⁾
Series D Convertible Preferred Stock	$0	08/10/2020		C			7,242	⁽³⁾	⁽³⁾	Common Stock	7,242	$0	0	I	See footnote⁽¹⁾
Series D Convertible Preferred Stock	$0	08/10/2020		C			171,695	⁽³⁾	⁽³⁾	Common Stock	171,695	$0	0	I	See footnote⁽²⁾

Explanation of Responses:

1. These shares are held by Advent Life Sciences LLP ("Advent"). The Reporting Person is a general partner of Advent, and disclaims beneficial ownership of the securities held by Advent except to the extent of his indirect pecuniary interest therein.

2. These shares are held by Advent Life Sciences Fund I LP. Advent is the general partner of Advent Life Sciences Fund II LP and the Reporting Person is a general partner of Advent. The Reporting Person disclaims beneficial ownership of the securities held by Advent Life Sciences Fund II LP except to the extent of his indirect pecuniary interest therein.

3. Each of the Series A Convertible Preferred Stock, Series B Convertible Preferred Stock, Series C Convertible Preferred Stock, and Series D Convertible Preferred Stock is convertible into the Issuer's Common Stock on a one-for-one basis for no additional consideration and has no expiration date.

	/s/ Charlie Piscitello as attorney-in-fact for Shahzad Malik	08/12/2020
	** 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).
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