Bronwyn Evans Form 3 EBR Systems / Bronwyn Evans ownership change

SEC Form 3

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^*

Evans Bronwyn

(Last) (First) (Middle)

480 OAKMEAD PARKWAY

(Street)

SUNNYVALE CA 94085

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
09/30/2024

3. Issuer Name and Ticker or Trading Symbol
EBR Systems, Inc. [ EBRCZ ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
	Officer (give title below)	Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	167,413(1)	I	By Bronwyn Evans and Peter Douglas Gordon

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Stock Option (right to buy)	(2)	11/21/2031	Common Stock	100,100	0.7992	D
Stock Option (right to buy)	(3)	04/03/2033	Common Stock	182,159	0.44	D
Stock Option (right to buy)	(4)	03/20/2034	Common Stock	163,637	0.55	I	By Bronwyn Evans and Peter Douglas Gordon

Explanation of Responses:

1. 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.

2. 1/3 of the shares subject to the stock option vest on the one-year anniversary as measured from 9/30/2021, and the remainder of the shares vest in 24 equal monthly installments thereafter, subject to continued employment or service through each such date.

3. 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.

4. 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.

	/s/ Gary W Doherty, Attorney-in-Fact	09/30/2024
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
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