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Ownership Document
|
| Schema Version: X0306 |
| Document Type: 4 |
| Period of Report: 9/13/22 |
| Not Subject to Section 16: 0 |
| Issuer: |
| Issuer CIK: 1610853 |
| Issuer Name: HELIUS MEDICAL TECHNOLOGIES, INC. |
| Issuer Trading Symbol: HSDT |
| Reporting Owner: |
| Reporting Owner ID: |
| | Owner CIK: 1871533 |
| | Owner Name: Favit-Van Pelt Antonella R. |
| Reporting Owner Address: |
| | Owner Street 1: C/O HELIUS MEDICAL TECHNOLOGIES, INC. |
| | Owner Street 2: 642 NEWTOWN YARDLEY ROAD, SUITE 100 |
| | Owner City: NEWTOWN |
| | Owner State: PA |
| | Owner ZIP Code: 18940 |
| | Owner State Description: |
| Reporting Owner Relationship: |
| | Is Director? No |
| | Is Officer? Yes |
| | Is Ten Percent Owner? No |
| | Is Other? No |
| | Officer Title: Chief Medical Officer |
| | Other Text: |
| Derivative Table: |
| Derivative Transaction: |
| | Security Title: |
| | | Value: Stock Option (Right to Buy) |
| | Conversion or Exercise Price: |
| | | Value: 0.54 |
| | Transaction Date: |
| | | Value: 9/13/22 |
| | Deemed Execution Date: |
| | Transaction Coding: |
| | | Transaction Form Type: 4 |
| | | Transaction Code: A |
| | | Equity Swap Involved? No |
| | Transaction Timeliness: |
| | Transaction Amounts: |
| | | Transaction Shares: |
| Value: 10,000 |
| | | Transaction Price Per Share: |
| Value: 0 |
| | | Transaction Acquired-Disposed Code: |
| Value: A |
| | Exercise Date: |
| | | Footnote ID: F1 |
| | Expiration Date: |
| | | Value: 9/12/32 |
| | Underlying Security: |
| | | Underlying Security Title: |
| Value: Common Stock |
| | | Underlying Security Shares: |
| Value: 10,000 |
| | Post-Transaction Amounts: |
| | | Shares Owned Following Transaction: |
| Value: 10,000 |
| | Ownership Nature: |
| | | Direct or Indirect Ownership: |
| Value: D |
| Footnotes: |
| Footnote - F1: Grant to the Reporting Person of a stock option under the Issuer's 2022 Equity Incentive Plan. The options vest in a series of twelve (12) successive equal quarterly installments on the last day of each quarter so that all of the options will be vested on the three-year anniversary of the grant date, subject to the Reporting Person's continued service through each applicable vesting period. |
| Owner Signature: |
| Signature Name: /s/ Emily Johns, by Power of Attorney |
| Signature Date: 9/14/22 |
