0001213900-24-015029.txt : 20240216
0001213900-24-015029.hdr.sgml : 20240216
20240216193911
ACCESSION NUMBER: 0001213900-24-015029
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20240214
FILED AS OF DATE: 20240216
DATE AS OF CHANGE: 20240216
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Fisher Douglas Carl
CENTRAL INDEX KEY: 0001572355
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40877
FILM NUMBER: 24650189
MAIL ADDRESS:
STREET 1: 587 PATROL RD
CITY: WOODSIDE
STATE: CA
ZIP: 94062
FORMER NAME:
FORMER CONFORMED NAME: Fisher Douglas
DATE OF NAME CHANGE: 20130315
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: CERO THERAPEUTICS HOLDINGS, INC.
CENTRAL INDEX KEY: 0001870404
STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836]
ORGANIZATION NAME: 03 Life Sciences
IRS NUMBER: 871088814
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 201 HASKINS WAY
STREET 2: SUITE 230
CITY: SOUTH SAN FRANCISCO
STATE: CA
ZIP: 94080
BUSINESS PHONE: 650-407-2376
MAIL ADDRESS:
STREET 1: 201 HASKINS WAY
STREET 2: SUITE 230
CITY: SOUTH SAN FRANCISCO
STATE: CA
ZIP: 94080
FORMER COMPANY:
FORMER CONFORMED NAME: PHOENIX BIOTECH ACQUISITION CORP.
DATE OF NAME CHANGE: 20210630
4
1
ownership.xml
X0508
4
2024-02-14
1
0001870404
CERO THERAPEUTICS HOLDINGS, INC.
CERO
0001572355
Fisher Douglas Carl
2201 BROADWAY, SUITE 705
OAKLAND
CA
94612
0
1
0
0
President
0
Class A Common Stock
2024-02-14
4
J
0
43300
A
43300
D
Series A Convertible Preferred Stock
10.00
2024-02-14
4
A
0
50
1000
A
Common Stock
5000
50
D
Warrants
11.50
2024-02-14
4
J
0
5000
0
A
2024-03-15
2029-02-14
Common Stock
5000
5000
D
Represents shares of Class A Common Stock or warrants, as applicable, distributed in-kind by Phoenix Biotech Sponsor, LLC (the "Sponsor") to its members, pro rata and without consideration.
On February 14, 2024, the reporting person acquired shares of Series A Convertible Preferred Stock (the "Series A Preferred Stock") in a private placement by the Issuer pursuant to the terms of a Securities Purchase Agreement dated as of February 5, 2024, as amended. Each share of Series A Preferred Stock has a stated value of $1,000 and, at the option of the holder, is convertible into a number of shares of Common Stock determined by dividing (x) the value of the shares of Series A Preferred Stock, plus any additional amounts thereon as of such date of determination, by (y) the conversion price, which is currently $10.00, subject to adjustments. The Series A Preferred Stock has no expiration date.
/s/ Chris Ehrlich, Attorney-in-Fact
2024-02-16