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