Initial Statement of Beneficial Ownership (3)
August 16 2022 - 11:55AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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Summers Andrew |
2. Date of Event Requiring Statement (MM/DD/YYYY)
7/25/2022
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3. Issuer Name and Ticker or Trading Symbol
Electromed, Inc. [ELMD]
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(Last)
(First)
(Middle)
500 SIXTH AVENUE NW |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Street)
NEW PRAGUE, MN 56071
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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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 | 323124 | I | By Summers Value Fund LP (1) |
Common Stock | 198569 | I | By SVP Deal Fund 1 LP (2) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
Explanation of Responses: |
(1) | Securities owned directly by Summers Value Fund LP ("Summers Value Fund"). Mr. Summers, as the Managing Member of each of Summers Value Partners GP LLC, the general partner of Summers Value Fund, and Summers Value Partners LLC ("Summers Value Partners"), the investment manager of Summers Value Fund, may be deemed to beneficially own the securities owned directly by Summers Value Fund. Mr. Summers expressly disclaims beneficial ownership of such securities except to the extent of his pecuniary interest therein. |
(2) | Securities owned directly by SVP Deal Fund 1 LP ("SVP Fund"). Mr. Summers, as the Managing Member of each of SVP Deal Fund 1 GP LLC, the general partner of SVP Fund, and Summers Value Partners, the investment manager of SVP Fund, may be deemed to beneficially own the securities owned directly by SVP Fund. Mr. Summers expressly disclaims beneficial ownership of such securities except to the extent of his pecuniary interest therein. |
Remarks: Exhibit List: EX-24 Power of Attorney |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Summers Andrew 500 SIXTH AVENUE NW NEW PRAGUE, MN 56071 | X |
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Signatures
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/s/ Joshua L. Colburn, Attorney-in-Fact | | 8/16/2022 |
**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). |
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 control number. |
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