0001209191-21-031234.txt : 20210510 0001209191-21-031234.hdr.sgml : 20210510 20210510162218 ACCESSION NUMBER: 0001209191-21-031234 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210507 FILED AS OF DATE: 20210510 DATE AS OF CHANGE: 20210510 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DeRienzis Joshua H CENTRAL INDEX KEY: 0001445552 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38832 FILM NUMBER: 21907541 MAIL ADDRESS: STREET 1: 4345 SOUTHPOINT BLVD CITY: JACKSONVILLE STATE: FL ZIP: 32216 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: SURGALIGN HOLDINGS, INC. CENTRAL INDEX KEY: 0001760173 STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842] IRS NUMBER: 832540607 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 520 LAKE COOK ROAD, SUITE 315 CITY: DEERFIELD STATE: IL ZIP: 60015 BUSINESS PHONE: 3864188888 MAIL ADDRESS: STREET 1: 520 LAKE COOK ROAD, SUITE 315 CITY: DEERFIELD STATE: IL ZIP: 60015 FORMER COMPANY: FORMER CONFORMED NAME: RTI Surgical Holdings, Inc. DATE OF NAME CHANGE: 20190308 FORMER COMPANY: FORMER CONFORMED NAME: Bears Holding Sub, Inc. DATE OF NAME CHANGE: 20181127 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-05-07 0 0001760173 SURGALIGN HOLDINGS, INC. SRGA 0001445552 DeRienzis Joshua H 520 LAKE COOK ROAD SUITE 315 DEERFIELD IL 60015 0 1 0 0 Chief Legal Officer Common Stock 2021-05-07 4 A 0 104697 0.00 A 249404 D Common Stock 2021-05-07 4 A 0 31611 0.00 A 281015 D Common Stock 2021-05-07 4 A 0 16574 0.00 A 297589 D The Restricted Stock Units will vest over three years with 1/3 of the shares vesting after year one and remaining 2/3 of the shares vesting prorated quarterly. Represents a portion of the 2020 short-term incentive plan; vests on May 7, 2022. Represents recoupment of lost wages during 2020; with 1/2 of the shares vesting after year one and remaining 1/2 of the shares after year two. /s/ Joshua H. DeRienzis 2021-05-10