Form 3 ICAD INC For: Nov 04 Filed by: CHRISTOPHER RICHARD
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November 14, 2016 3:36 PM EST
| 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
|
| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Expires: |
December 31, 2014 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
1. Name and Address of Reporting Person
*
| C/O ICAD, INC. |
| 98 SPIT BROOK ROAD, SUITE 100 |
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year)
11/04/2016
|
3. Issuer Name
and
Ticker or Trading Symbol
ICAD INC
[
icad
]
|
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| Chief Financial Officer, EVPF |
|
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)
|
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 |
| Explanation of Responses: |
|
/s/Annette Heroux, Attorney-in-Fact |
11/14/2016 |
|
** 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
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. |
LIMITED POWER OF ATTORNEY FOR
SECTION 16 REPORTING OBLIGATIONS
Know all by these presents, that the undersigned
hereby makes, constitutes and appoints
Annette Heroux as the undersigned's true and
lawful attorney-in-fact, with full power and
authority as hereinafter described on behalf
of and in the name, place and stead of the
undersigned to:
(1) prepare, execute in the undersigned's name
and on the undersigned's behalf and submit to
the US Securities and Exchange Commission (the
"SEC") a Form ID including amendments thereto and
any other documents necessary or appropriate to obtain
codes and passwords enabling the undersigned to make
electronic filings with the SEC of reports required
Section 16(a) of the Securities Exchange Act of 1934
Or any rule or regulation promulgated thereunder, as
Amended from time to time ("the Exchange Act") and any
Other regulation of the SEC;
(2) prepare, execute, acknowledge, deliver and Forms
3, 4, and 5 (including any amendments thereto) with
Respect to the securities of iCAD Inc. a Delaware
corporation (the "Company"), with the SEC, any national
securities exchanges and the Company, as considered
necessary or advisable under Section 16(a) of the
Exchange Act;
(3) seek or obtain, as the undersigned's
representative and on the undersigned's behalf,
information on transactions in the Company's
securities from any third party, including brokers,
employee benefit plan administrators and trustees,
and the undersigned hereby authorizes any such
person to release any such information to the
undersigned and approves and ratifies any such
release of information; and
(4) perform any and all other acts which in
the discretion of such attorney-in-fact are
necessary or desirable for and on behalf of the
undersigned in connection with the foregoing.
The undersigned acknowledges that:
(1) this Power of Attorney authorizes,
but does not require, each such attorney-in-fact
to act in their discretion on information provided
to such attorney-in-fact without independent
verification of such information;
(2) any documents prepared and/or executed
by either such attorney-in-fact on behalf of
the undersigned pursuant to this Power of
Attorney will be in such form and will contain
such information and disclosure as such
attorney-in-fact, in his or her discretion,
deems necessary or desirable;
(3) neither the Company nor either of such
attorneys-in-fact assumes (i) any liability
for the undersigned's responsibility to comply
with the requirement of the Exchange Act, (ii)
any liability of the undersigned for any failure
to comply with such requirements, or (iii) any
obligation or liability of the undersigned for
profit disgorgement under Section 16(b) of the
Exchange Act; and
(4) this Power of Attorney does not relieve
the undersigned from responsibility for
compliance with the undersigned's obligations
under the Exchange Act, including without
limitation the reporting requirements under
Section 16 of the Exchange Act.
The undersigned hereby gives and grants each
of the foregoing attorneys-in-fact full power
and authority to do and perform all and every
act and thing whatsoever requisite, necessary
or appropriate to be done in and about the
foregoing matters as fully to all intents
and purposes as the undersigned might or could
do if present, hereby ratifying all that each
such attorney-in-fact of, for and on behalf
of the undersigned, shall lawfully do or
cause to be done by virtue of this Limited
Power of Attorney.
This Power of Attorney shall remain in
full force and effect until revoked by
the undersigned in a signed writing delivered
to each such attorney-in-fact.
IN WITNESS WHEREOF, the undersigned has
caused this Power of Attorney to be
executed as of this 9th day of
November, 2016.
/s/ Richard Christopher
Signature
Richard Christopher
Print Name
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