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Ownership Document |
Schema Version: X0306 |
Document Type: 4 |
Period of Report: 4/1/21 |
Not Subject to Section 16: 0 |
Issuer: |
| Issuer CIK: 1522860 |
| Issuer Name: Acutus Medical, Inc. |
| Issuer Trading Symbol: AFIB |
Reporting Owner: |
| Reporting Owner ID: |
| | Owner CIK: 1843669 |
| | Owner Name: Roman David |
| Reporting Owner Address: |
| | Owner Street 1: C/O ACUTUS MEDICAL, INC. |
| | Owner Street 2: 2210 FARADAY AVE., SUITE 100 |
| | Owner City: CARLSBAD |
| | Owner State: CA |
| | Owner ZIP Code: 92008 |
| | Owner State Description: |
| Reporting Owner Relationship: |
| | Is Director? No |
| | Is Officer? Yes |
| | Is Ten Percent Owner? No |
| | Is Other? No |
| | Officer Title: Chief Financial Officer |
| | Other Text: |
Non-Derivative Table: |
| Non-Derivative Transaction: |
| | Security Title: |
| | | Value: Common Stock |
| | Transaction Date: |
| | | Value: 4/1/21 |
| | Deemed Execution Date: |
| | Transaction Coding: |
| | | Transaction Form Type: 4 |
| | | Transaction Code: A |
| | | Equity Swap Involved? No |
| | Transaction Timeliness: |
| | Transaction Amounts: |
| | | Transaction Shares: |
| Value: 36,603 |
| Footnote ID: F1 |
| | | Transaction Price Per Share: |
| Value: 0 |
| | | Transaction Acquired-Disposed Code: |
| Value: A |
| | Post-Transaction Amounts: |
| | | Shares Owned Following Transaction: |
| Value: 36,603 |
| | Ownership Nature: |
| | | Direct or Indirect Ownership: |
| Value: D |
Derivative Table: |
| Derivative Transaction: |
| | Security Title: |
| | | Value: Stock Options (Right to Buy) |
| | Conversion or Exercise Price: |
| | | Value: 13.66 |
| | Transaction Date: |
| | | Value: 4/1/21 |
| | Deemed Execution Date: |
| | Transaction Coding: |
| | | Transaction Form Type: 4 |
| | | Transaction Code: A |
| | | Equity Swap Involved? No |
| | Transaction Timeliness: |
| | Transaction Amounts: |
| | | Transaction Shares: |
| Value: 77,335 |
| | | Transaction Price Per Share: |
| Value: 0 |
| | | Transaction Acquired-Disposed Code: |
| Value: A |
| | Exercise Date: |
| | | Footnote ID: F2 |
| | Expiration Date: |
| | | Value: 4/1/31 |
| | Underlying Security: |
| | | Underlying Security Title: |
| Value: Common Stock |
| | | Underlying Security Shares: |
| Value: 77,335 |
| | Post-Transaction Amounts: |
| | | Shares Owned Following Transaction: |
| Value: 77,335 |
| | Ownership Nature: |
| | | Direct or Indirect Ownership: |
| Value: D |
Footnotes: |
| Footnote - F1: Represents shares of Common Stock to be delivered in settlement of a restricted stock unit award upon continued service through the designated vesting event. |
| Footnote - F2: This option vests over four years from April 1, 2021, with 1/4 vesting on the first anniversary of the vesting commencement date, and the remainder vesting in 36 equal monthly installments, subject to continued service through each such vesting date. |
Owner Signature: |
| Signature Name: /s/ Tom Sohn as attorney-in-fact for David Roman |
| Signature Date: 4/2/21 |