Initial Statement of Beneficial Ownership (3)
16 Agosto 2021 - 6:56PM
Edgar (US Regulatory)
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
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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
*
Williams Charles O |
2. Date of Event Requiring Statement (MM/DD/YYYY)
8/11/2021
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3. Issuer Name and Ticker or Trading Symbol
Surrozen, Inc./DE [SRZN]
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(Last)
(First)
(Middle)
C/O SURROZEN, INC., 171 OYSTER POINT BLVD., SUITE 400 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) Chief Financial Officer / |
(Street)
SOUTH SAN FRANCISCO, CA 94080
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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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) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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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 |
Employee Stock Option (right to buy) | (1) | 12/13/2030 | Common Stock | 175648 (2) | $0.90 | D | |
Explanation of Responses: |
(1) | Twenty-five percent of the shares subject to the Stock Option vests on the first anniversary of the vesting commencement date, and the remainder vests in 36 equal monthly installments thereafter for the following three years. |
(2) | Received pursuant to the Business Combination Agreement (the "BCA"), dated April 15, 2021, by and among the Issuer (fka "Consonance-HFW Acquisition Corp"), Perseverance Merger Sub Inc. ("Merger Sub"), and Surrozen, Inc. (the "Original Surrozen"). Under the terms of the BCA, among other things, Merger Sub merged with and into the Original Surrozen, with Original Surrozen surviving as a wholly-owned subsidiary of the Issuer (the "Business Combination"), the Original Surrozen changed its name to Surrozen Operating, Inc., and the Issuer changed its name to Surrozen, Inc. In addition, per the terms of the BCA, each share and equity award of the Original Surrozen outstanding as of effective time of the Business Combination was exchanged for shares of the Issuer's Common Stock or comparable equity awards that are settled or are exercisable for shares of the Issuer's Common Stock, as applicable, at the exchange ratio of 0.175648535. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Williams Charles O C/O SURROZEN, INC. 171 OYSTER POINT BLVD., SUITE 400 SOUTH SAN FRANCISCO, CA 94080 |
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| Chief Financial Officer |
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Signatures
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/s/ Sheela Mohan-Peterson, Attorney-in-Fact for Charles O. Williams | | 8/16/2021 |
**Signature of Reporting Person | Date |
Consonance HFW Acquisition (AMEX:CHFW)
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