Filing Details
- Accession Number:
- 0000950170-23-065608
- Form Type:
- 13G Filing
- Publication Date:
- 2023-11-20 19:00:00
- Filed By:
- Shukla Rajiv
- Company:
- Carmell Corp
- Filing Date:
- 2023-11-21
- SEC Url:
- 13G Filing
SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION | OMB APPROVAL | |
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☐ | Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10. | OMB Number: 3235-0287 Estimated average burden hours per response: 0.5 | |
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1. Name and Address of Reporting Person* Shukla Rajiv | 2. Issuer Name and Ticker or Trading Symbol Carmell Corporation CTCX | 5. Relationship of Reporting Person(s) to Issuer
X DirectorX 10% Owner X Officer (give title below)Other (specify below)
Chairman and Chief Executive Officer |
(Last) (First) (Middle) | ||
c/o Carmell Corporation 2403 Sidney Street, Suite 300 | 3. Date of Earliest Transaction (Month/Day/Year) 11/17/2023 | |
(Street) | ||
Pittsburgh PA 15203 | 4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line) XForm filed by One Reporting Person Form filed by More than One Reporting Person |
(City) (State) (Zip) |
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 11/17/2023 | 11/21/2023 | P |
| 2,000 | A | $2.6899 (1) | 10,612 | D |
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Common Stock | 11/20/2023 | 11/22/2023 | P |
| 3,750 | A | $2.6179 (2) | 14,362 | D |
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Common Stock | 11/21/2023 | 11/24/2023 | P |
| 200 | A | $2.4857 | 14,562 | D |
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Common Stock |
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| 4,249,908 | I | By AHAC Sponsor III LLC (3) |
ACTIVE/126196759.1
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||
1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
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Explanation of Responses:
| /s/ Rajiv Shukla | 11/21/2023 |
| ** Signature of Reporting Person | Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
ACTIVE/126196759.1