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Ownership Document
|
| Schema Version: X0206 |
| Document Type: 3 |
| Period of Report: 6/14/22 |
| No Securities Owned: 0 |
| Issuer: |
| Issuer CIK: 1468492 |
| Issuer Name: Heart Test Laboratories, Inc. |
| Issuer Trading Symbol: HSCS |
| Reporting Owner: |
| Reporting Owner ID: |
| | Owner CIK: 1746671 |
| | Owner Name: Bent Bruce |
| Reporting Owner Address: |
| | Owner Street 1: 550 RESERVE STREET, SUITE 360 |
| | Owner Street 2: |
| | Owner City: SOUTHLAKE |
| | Owner State: TX |
| | Owner ZIP Code: 76092 |
| | Owner State Description: |
| Reporting Owner Relationship: |
| | Is Director? Yes |
| | Is Officer? No |
| | Is Ten Percent Owner? No |
| | Is Other? No |
| Non-Derivative Table: |
| Non-Derivative Holding: |
| | Security Title: |
| | | Value: Common Stock |
| | Post-Transaction Amounts: |
| | | Shares Owned Following Transaction: |
| Value: 1,638 |
| | Ownership Nature: |
| | | Direct or Indirect Ownership: |
| Value: I |
| | | Nature of Ownership: |
| Value: By Spouse |
| Derivative Table: |
| Derivative Holding: |
| | Security Title: |
| | | Value: Director Stock Option (Right to Buy) |
| | Conversion or Exercise Price: |
| | | Value: 3.47 |
| | Exercise Date: |
| | | Footnote ID: F1 |
| | Expiration Date: |
| | | Value: 3/1/32 |
| | Underlying Security: |
| | | Underlying Security Title: |
| Value: Common Stock |
| | | Underlying Security Shares: |
| Value: 1,894 |
| | Ownership Nature: |
| | | Direct or Indirect Ownership: |
| Value: D |
| Derivative Holding: |
| | Security Title: |
| | | Value: Director Stock Option (Right to Buy) |
| | Conversion or Exercise Price: |
| | | Value: 3.47 |
| | Exercise Date: |
| | | Footnote ID: F2 |
| | Expiration Date: |
| | | Value: 3/1/32 |
| | Underlying Security: |
| | | Underlying Security Title: |
| Value: Common Stock |
| | | Underlying Security Shares: |
| Value: 1,894 |
| | Ownership Nature: |
| | | Direct or Indirect Ownership: |
| Value: D |
| Footnotes: |
| Footnote - F1: The entire option has become fully-vested and may be exercised at any time at the Holder's election. |
| Footnote - F2: The option becomes fully-vested and may be exercised at any time at Holder's election upon the achievement of performance-based criteria related to approval by the U.S. Food and Drug Administration of certain of the Company's products. As of the date of this filing, the performance-based criteria have not been satisfied. |
| Remarks: |
| Owner Signature: |
| Signature Name: /s/ Mark Hilz, Attorney-In-Fact |
| Signature Date: 6/14/22 |
