# EDGAR Filing Document

**Accession Number:** 0001468492
**File Stem:** 0000899243-23-009451
**Filing Date:** 2023-3
**Character Count:** 7044
**Document Hash:** a4956330a63165b04f6d4a946659322f
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0000899243-23-009451.hdr.sgml**: 20230322

**ACCESSION NUMBER**: 0000899243-23-009451

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230320

**FILED AS OF DATE**: 20230322

**DATE AS OF CHANGE**: 20230322

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** HILZ MARK T
- **CENTRAL INDEX KEY:** 0001016157
- **STANDARD INDUSTRIAL CLASSIFICATION:** WHOLESALE-COMPUTER & PERIPHERAL EQUIPMENT & SOFTWARE [5045]
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-41422
- **FILM NUMBER:** 23754185

**MAIL ADDRESS:**
- **STREET 1:** 3301 DAKOTA DRIVE
- **CITY:** NORTHLAKE
- **STATE:** TX
- **ZIP:** 76226
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Heart Test Laboratories, Inc.
- **CENTRAL INDEX KEY:** 0001468492
- **STANDARD INDUSTRIAL CLASSIFICATION:** ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842]
- **IRS NUMBER:** 261344466
- **STATE OF INCORPORATION:** TX
- **FISCAL YEAR END:** 0430

**BUSINESS ADDRESS:**
- **STREET 1:** 550 RESERVE ST, SUITE 360
- **CITY:** SOUTHLAKE
- **STATE:** TX
- **ZIP:** 76092
- **BUSINESS PHONE:** 682-237-7781

**MAIL ADDRESS:**
- **STREET 1:** 550 RESERVE ST, SUITE 360
- **CITY:** SOUTHLAKE
- **STATE:** TX
- **ZIP:** 76092

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>HILZ MARK T<br><sub>(Last) (First) (Middle)</sub><br>C/O HEART TEST LABORATORIES, INC.,<br>550 RESERVE STREET, SUITE 360<br><sub>(Street)</sub><br>SOUTHLAKE, TX 76092<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-03-20 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [ ] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_See Remarks_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Heart Test Laboratories, Inc. [ HSCS ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
|  |  |  |  |  |  |  |  |  |  |  |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Employee Stock Option (Right to Buy) | 0.97<sup>(1)</sup> | 2023-03-20 |  | A |  | 300000 |  | <sup>(2)</sup> | 2033-03-20<sup>(3)</sup> | Common Stock | 300000 | <sup>(1)</sup> | 300000 | D |  |

---

### Footnotes:

(1) These options were granted to the Reporting Person effective as of March 20, 2023 (the "Effective Date"), pursuant to the approval of the Issuer's board of directors on March 20, 2023.

(2) One-third of the options shall vest on the 12-month anniversary of the Effective Date, with an additional 8.333% of the options vesting on each of June 20, 2024 (the "Subsequent Vesting Date") and thereafter on each successive three-month anniversary of the Subsequent Vesting Date for the next seven fiscal quarters, subject to the Reporting Person's continued employment with the Issuer through each applicable vesting date and subject to the terms of the Issuer's 2023 Equity Incentive Plan (the "2023 Plan"). These options shall become fully-vested and may be exercised at any time at the Reporting Person's election upon the Issuer receiving regulatory clearance for its MyoVista wavECG device (or similar such product owned by the Issuer) from the U.S. Food and Drug Administration. As of the date of this filing, such regulatory clearance has not been received.

(3) These options expire ten years from the Effective Date, unless terminated sooner in accordance with the 2023 Plan or the underlying options grant agreement.

**Remarks:**
Chief Operating Officer and Secretary

**Signature:** /s/ Andrew Simpson, Attorney-In-Fact  
**Date:** 2023-03-22

### Remarks:

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 4 (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).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

**Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.**