Allan R. Will - 30 Sep 2024 Form 3/A - Amendment Insider Report for EBR Systems, Inc. (EBRCZ)

Role
Director
Signature
/s/ Gary W Doherty, Attorney-in-Fact
Issuer symbol
EBRCZ
Transactions as of
30 Sep 2024
Net transactions value
$0
Form type
3/A - Amendment
Filing time
22 May 2025, 20:34:37 UTC
Date Of Original Report
30 Sep 2024
Previous filing
01 Feb 2024
Next filing
02 Jan 2025
SEC
View on sec.gov

Reporting Owners (1)

Name Relationship Address Signature Signature date CIK
Will Allan R Director 480 OAKMEAD PARKWAY, SUNNYVALE /s/ Gary W Doherty, Attorney-in-Fact 22 May 2025 0001367902

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
holding EBRCZ Common Stock 5,827,224 30 Sep 2024 By the Allan R. Will Trust U/A Dtd 6/14/2012 F1
holding EBRCZ Common Stock 600,000 30 Sep 2024 By Taphne Ann Lux F1, F2, F3

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Underlying Class Amount Exercise Price Ownership Footnotes
holding EBRCZ Stock Option (right to buy) 30 Sep 2024 Common Stock 2,305,564 $0.1400 Direct F4
holding EBRCZ Stock Option (right to buy) 30 Sep 2024 Common Stock 58,500 $0.1600 Direct F4
holding EBRCZ Stock Option (right to buy) 30 Sep 2024 Common Stock 171,121 $0.7992 Direct F5
holding EBRCZ Stock Option (right to buy) 30 Sep 2024 Common Stock 182,159 $0.4400 Direct F6
holding EBRCZ Stock Option (right to buy) 30 Sep 2024 Common Stock 163,637 $0.5500 Direct F7
holding EBRCZ Warrant (right to buy) 30 Sep 2024 Common Stock 63,820 $0.5891 By the Allan R. Will Trust U/A Dtd 6/14/2012
holding EBRCZ Warrant (right to buy) 30 Sep 2024 Common Stock 63,820 $0.5891 By the Allan R. Will Trust U/A Dtd 6/14/2012
holding EBRCZ Warrant (right to buy) 30 Sep 2024 Common Stock 25,528 $0.5891 By the Allan R. Will Trust U/A Dtd 6/14/2012
holding EBRCZ Warrant (right to buy) 30 Sep 2024 Common Stock 48,422 $0.5891 By the Allan R. Will Trust U/A Dtd 6/14/2012
holding EBRCZ Warrant (right to buy) 30 Sep 2024 Common Stock 48,422 $0.5891 By the Allan R. Will Trust U/A Dtd 6/14/2012
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 Represents shares of the Issuer's common stock underlying the same amount of Chess Depositary Interests ("CDIs"). The CDIs are traded on the Australian Securities Exchange (the "ASX") and are held by CHESS Depositary Nominees Pty, Limited, a subsidiary of ASX Limited, the company that operates the ASX.
F2 On September 30, 2024, the reporting person mistakenly filed a Form 3 reporting the indirect ownership of 628,000 shares of common stock. After further analysis, it was determined that Mr. Will does have 600,000 shares of indirect beneficial ownership of the Issuer's common stock held by Taphne Ann Lux and underlying the same amount of CDIs.
F3 Family Member
F4 Fully Vested.
F5 1/3 of the shares subject to the stock option vest on the one-year anniversary as measured from 10/1/2021, and the remainder of the shares vest in 24 equal monthly installments thereafter, subject to continued employment or service through each such date. If applicable, vesting accelerates as provided in, and subject to the terms and conditions of, that certain Severance and Change of Control Agreement between the Issuer and the Reporting Person, as may be amended from time to time.
F6 1/12 of the Option vests in equal monthly installments as measured from 5/22/2023, subject to continued employment or service through each such date. If applicable, vesting accelerates as provided in, and subject to the terms and conditions of, that certain Severance and Change of Control Agreement between the Issuer and the Reporting Person, as may be amended from time to time.
F7 1/12 of the Option vests in equal monthly installments as measured from 5/29/2024, subject to continued employment or service through each such date. If applicable, vesting accelerates as provided in, and subject to the terms and conditions of, that certain Severance and Change of Control Agreement between the Issuer and the Reporting Person, as may be amended from time to time.