EBR Systems Inc.

10/15/2024 | Press release | Distributed by Public on 10/15/2024 04:43

Initial Statement of Beneficial Ownership - Form 3

Ownership Submission
FORM 3
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person *
Carnegie Mark H.
2. Date of Event Requiring Statement (Month/Day/Year)
2024-09-30
3. Issuer Name and Ticker or Trading Symbol
EBR Systems, Inc. [EBRCZ]
(Last) (First) (Middle)
C/O M.H. CARNEGIE & CO. PTY LTD , SUITE 210-F3, 122 LANG ROAD
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
5. If Amendment, Date Original Filed(Month/Day/Year)
(Street)
MOORE PARK C3 2021
6. Individual or Join/Group Filing(Check Applicable Line)
___ Form filed by One Reporting Person
_X_ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Beneficially Owned
1.Title of Security 2. Amount of Securities Beneficially Owned 3. Ownership Form: Direct (D) or Indirect (I) 4. Nature of Indirect Beneficial Ownership
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security 2. Date Exercisable and Expiration Date 3. Title and Amount of Securities Underlying Derivative Security 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) 6. Nature of Indirect Beneficial Ownership
Date Exercisable Expriation Date Title Amount or Number of Shares

Reporting Owners

Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Carnegie Mark H.
C/O M.H. CARNEGIE & CO. PTY LTD
SUITE 210-F3, 122 LANG ROAD
MOORE PARK, C32021

X

M.H. Carnegie & Co. Pty Ltd
SUITE 210-F3, THE ENTERTAINMENT QUARTER,
122 LANG ROAD
MOORE PARK, C32021

X

Signatures

/s/ Mark H. Carnegie 2024-10-11
**Signature of Reporting Person Date
/s/ M.H. Carnegie & Co. Pty Ltd, by Mark H. Carnegie, Chief Executive Officer 2024-10-11
**Signature of Reporting Person Date

Explanation of Responses:

(*) If the form is filed by more than one reporting person, see Instruction 5(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).
(1) Represents shares of the Issuer's common stock underlying the same amount of Chess Depository Interests ("CDIs"). The CDIs trade 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.
(2) Mark H. Carnegie is controlling member of M. Carnegie Pty Ltd and as such may be deemed to be the beneficial owner for purposes of Rule 16a-1(a) under the U.S. Securities Exchange Act of 1934, as amended (the "Exchange Act"), of the reported securities held by M. Carnegie Pty Ltd.
(3) M.H. Carnegie & Co. Pty Ltd, an Australian regulated company, serves as the investment manager for, and as such may be deemed to be the beneficial owner for purposes of Rule 16a-1(a) under the Exchange Act of the reported securities held by, Carnegie Venture Capital Pty Ltd, an Australian domiciled corporate limited partnership. Mark H. Carnegie is controlling member of M.H. Carnegie & Co. Pty Ltd and as such may be deemed to be the shared beneficial owner for purposes of Rule 16a-1(a) under the Exchange Act of the reported securities held by Carnegie Venture Capital Pty Ltd. Carnegie Venture Capital Pty Ltd, M.H. Carnegie & Co. Pty Ltd, and Mark H. Carnegie each disclaim beneficial ownership of the reported securities except to the extent of its or his pecuniary interest therein.
(4) M.H. Carnegie & Co. Pty Ltd, an Australian regulated company, serves as the investment manager for, and as such may be deemed to be the beneficial owner for purposes of Rule 16a-1(a) under the Exchange Act of the reported securities held by, Carnegie Innovation Fund No 2 LP, an Australian domiciled registered limited partnership. Mark H. Carnegie is controlling member of M.H. Carnegie & Co. Pty Ltd and as such may be deemed to be the shared beneficial owner for purposes of Rule 16a-1(a) under the Exchange Act of the reported securities held by Carnegie Innovation Fund No 2 LP. Carnegie Innovation Fund No 2 LP, M.H. Carnegie & Co. Pty Ltd, and Mark H. Carnegie each disclaim beneficial ownership of the reported securities except to the extent of its or his pecuniary interest therein.
(5) M.H. Carnegie & Co. Pty Ltd, an Australian regulated company, serves as the investment manager for, and as such may be deemed to be the beneficial owner for purposes of Rule 16a-1(a) under the Exchange Act of the reported securities held by, MHC Fund Services B Pty Ltd, an Australian domiciled investment trust. Mark H. Carnegie is controlling member of M.H. Carnegie & Co. Pty Ltd and as such may be deemed to be the shared beneficial owner for purposes of Rule 16a-1(a) under the Exchange Act of the reported securities held by MHC Fund Services B Pty Ltd. MHC Fund Services B Pty Ltd, M.H. Carnegie & Co. Pty Ltd, and Mark H. Carnegie each disclaim beneficial ownership of the reported securities except to the extent of its or his pecuniary interest therein.
(6) M.H. Carnegie & Co. Pty Ltd, an Australian regulated company, serves as the investment manager for, and as such may be deemed to be the beneficial owner for purposes of Rule 16a-1(a) under the Exchange Act of the reported securities held by, MHC Fund Services 2A Pty Ltd, an Australian domiciled investment trust. Mark H. Carnegie is controlling member of M.H. Carnegie & Co. Pty Ltd and as such may be deemed to be the shared beneficial owner for purposes of Rule 16a-1(a) under the Exchange Act of the reported securities held by MHC Fund Services 2A Pty Ltd. MHC Fund Services 2A Pty Ltd, M.H. Carnegie & Co. Pty Ltd, and Mark H. Carnegie each disclaim beneficial ownership of the reported securities except to the extent of its or his pecuniary interest therein.
(7) Includes 854,018 shares held on behalf of Trevor J. Moody, a director of the Issuer. Mark H. Carnegie is controlling member of M.H. Carnegie & Co. Pty Ltd and as such may be deemed to be the shared beneficial owner for purposes of Rule 16a-1(a) under the Exchange Act of the reported securities directly held by M.H. Carnegie & Co. Pty Ltd, an Australian regulated company. M.H. Carnegie & Co. Pty Ltd and Mark H. Carnegie each disclaim beneficial ownership of the reported securities except to the extent of its or his pecuniary interest therein.
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