Amended Statement of Beneficial Ownership (3/a)
May 20 2022 - 07:34PM
Edgar (US Regulatory)
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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
Estimated average burden
hours per response... 0.5 |
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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 * Mackey Marc E. |
2. Date of Event Requiring Statement
(MM/DD/YYYY)
5/10/2022
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3. Issuer Name and Ticker or Trading
Symbol SURGALIGN HOLDINGS, INC. [SRGA] |
|
(Last)
(First)
(Middle)
520 LAKE COOK RD, SUITE 315 |
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
___X___ Officer (give title
below) _____
Other (specify below)
EVP, Digital Surgery / |
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(Street)
DEERFIELD, IL 60015
(City)
(State)
(Zip)
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5. If Amendment, Date Original
Filed(MM/DD/YYYY)
5/20/2022
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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 |
17917 (1) |
D |
|
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
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) |
The total number of shares
was erroneously reported on the original Form-3 as 9,997. The
corrected total number of shares includes 3,371 shares issued as
Restricted Stock Units that vest over three years from the 5/7/2021
grant date, with one-third of shares vesting after one year and one
eighth (1/8) of the remaining shares vesting quarterly beginning on
the eighteenth month following the date of the award and 216 shares
issued as Restricted Stock Units that vested in its entirety on
5/7/2022. |
Reporting
Owners
|
|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
Mackey Marc E.
520 LAKE COOK RD
SUITE 315
DEERFIELD, IL 60015 |
|
|
EVP, Digital Surgery |
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Signatures
|
|
by Jessica Rumschlag as attorney in
fact |
|
5/20/2022 |
| **Signature of Reporting
Person |
Date |
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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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