0001209191-22-030942.txt : 20220520
0001209191-22-030942.hdr.sgml : 20220520
20220520152412
ACCESSION NUMBER: 0001209191-22-030942
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20220510
FILED AS OF DATE: 20220520
DATE AS OF CHANGE: 20220520
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Mackey Marc E.
CENTRAL INDEX KEY: 0001930308
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38832
FILM NUMBER: 22947263
MAIL ADDRESS:
STREET 1: 520 LAKE COOK ROAD
STREET 2: SUITE 315
CITY: DEERFIELD
STATE: IL
ZIP: 60015
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
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2022-05-10
0
0001760173
SURGALIGN HOLDINGS, INC.
SRGA
0001930308
Mackey Marc E.
520 LAKE COOK RD
SUITE 315
DEERFIELD
IL
60015
0
1
0
0
EVP, Digital Surgery
Common Stock
9997
D
Warrants (right to buy)
18.00
2022-02-15
2027-02-15
Common Stock
3250
D
Employee stock option (right to buy)
51.90
2021-05-07
2031-05-06
Common Stock
6357
D
Employee stock option (right to buy)
51.90
2021-05-07
2031-05-06
Common Stock
408
D
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.
Includes 2,119 shares vested at the time of this filing.
Total reported options are vested as of this filing.
by Jessica Rumschlag as attorney in fact
2022-05-20
EX-24
2
poa.txt
POA DOCUMENT
LIMITED POWER OF ATTORNEY FOR SECTION 16 REPORTING OBLIGATIONS
The undersigned makes, constitutes and appoints each of David Lyle, Terry Rich,
and Jessica Rumschlag as the undersigneds true and lawful attorney-in-fact, with
full power and authority as described below on behalf of and in the name, place
and stead of the undersigned to: (1) prepare, execute, acknowledge, deliver and
file Forms 3, 4 and 5 (including any amendments to such Forms) with respect to
the securities of Surgalign Holdings, Inc., a Delaware corporation (the
Company), with the United States Securities and Exchange Commission, any
national securities exchanges and the Company, as considered necessary or
advisable under Section 16(a) of the Securities Exchange Act of 1934 and the
rules and regulations promulgated thereunder, as amended from time to time (the
Exchange Act); (2) seek or obtain, as the undersigneds representative and on the
undersigneds behalf, information on transactions in the Companys securities from
any third party, including brokers, employee benefit plan administrators and
trustees, and the undersigned authorizes any such person to release any such
information to the undersigned and approves and ratifies any such release of
information; and (3) 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 above. The undersigned acknowledges that: (1)
this Limited Power of Attorney authorizes, but does not require, such
attorney-in-fact to act in his or her discretion on information provided to such
attorney-in-fact without independent verification of such information; (2) any
documents prepared and/or executed by such attorney-in-fact on behalf of the
undersigned pursuant to this Limited 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 such
attorney-in-fact assumes: (i) any liability for the undersigneds 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 Limited Power of Attorney does not
relieve the undersigned from responsibility for compliance with the undersigneds
obligations under the Exchange Act, including without limitation the reporting
requirements under Section 16 of the Exchange Act. The undersigned gives and
grants the above 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 above matters as fully to all intents and purposes as the
undersigned might or could do if present, ratifying all that 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 Limited Power
of Attorney shall remain in full force and effect until revoked by the
undersigned in a signed writing delivered to such attorney-in-fact or until the
undersigned is no longer required to file Forms 3, 4, and 5 with regards to the
undersigneds ownership of or transaction in the Companys securities.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 18th day of May, 2022.
/s/ Marc Mackey
Signature
Marc Mackey
Print Name
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of San Diego
On May 18, 2022 before me, Jennifer Russell, a notary public, personally
appeared Marc E. Mackey, who proved to me on the basis of satisfactory evidence
to be the person whose name is subscribed to the within instrument and
acknowledged to me that he executed the same in his authorized capacity, and
that by his signature on the instrument the person, or the entity upon behalf of
which the person acted, executed the instrument. I certify under PENALTY OF
PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
/s/ Jennifer Russell
Signature of Notary
My commission expires: January 8, 2026
My commission #: 2389849