SEC FORM 3

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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^*

Szela Mary T

(Last)

(First)

(Middle)

6272 W. 91ST AVENUE

(Street)

WESTMINSTER

80031

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
08/10/2023

3. Issuer Name and Ticker or Trading Symbol
TriSalus Life Sciences, Inc. [ TLSI ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
X	Officer (give title below)	Other (specify below)
	CEO and President

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
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)
Common Stock	279,963⁽¹⁾⁽²⁾	D

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
Employee Stock Option (right to buy)	⁽³⁾	01/29/2028	Common Stock	177,973⁽¹⁾	$1.22	D
Employee Stock Option (right to buy)	⁽⁴⁾	10/05/2030	Common Stock	17,302⁽¹⁾	$0.41	D
Employee Stock Option (right to buy)	⁽³⁾	04/20/2031	Common Stock	101,345⁽¹⁾	$0.41	D
Employee Stock Option (right to buy)	⁽⁵⁾	11/02/2031	Common Stock	216,287⁽¹⁾	$2.43	D
Employee Stock Option (right to buy)	⁽⁶⁾	04/19/2032	Common Stock	55,616⁽¹⁾	$2.43	D
Employee Stock Option (right to buy)	⁽⁷⁾	05/18/2033	Common Stock	58,409⁽¹⁾	$10.3	D

Explanation of Responses:

1. The securities reported herein were acquired by the Reporting Person prior to the Reporting Person becoming a director and an executive officer of the Issuer. The Reporting Person was appointed as a director and an executive officer of the Issuer effective immediately after the effective time of the Merger (as defined in that certain Agreement and Plan of Merger, dated as of November 11, 2022, as amended, by and among the Issuer, MTAC Merger Sub, Inc., and TriSalus Operating Life Sciences, Inc.).

2. Includes 36,774 shares issued pursuant to a restricted stock unit award ("RSU"). The RSU vests in four equal annual installments commencing on October 5, 2023, subject to the Reporting Person's continued service with the Issuer on each respective vesting date.

3. The shares subject to this stock option became fully vested on January 22, 2022.

4. The shares subject to this stock option vest in 48 equal monthly installments from the vesting commencement date of October 1, 2020, subject to the Reporting Person's continued service with the Issuer on each respective vesting date.

5. Twenty-five percent of the shares subject to the option vested on November 3, 2022, the first anniversary of the vesting commencement date, and the remainder vests in 36 equal monthly installments thereafter, subject to the Reporting Person's continued service with the Issuer on each respective vesting date.

6. Seventy-five percent of the shares subject to this stock option vests on April 20, 2025, the third anniversary of the vesting commencement date, with the remainder vesting in 12 equal monthly installments thereafter, subject to the Reporting Person's continued service with the Issuer on each respective vesting date.

7. Twenty-five percent of the shares subject to the option vests on May 19, 2024, the first anniversary of the vesting commencement date, and the remainder vests in 36 equal monthly installments thereafter, subject to the Reporting Person's continued service with the Issuer on each respective vesting date.

Remarks:

	/s/ Mary Szela	08/14/2023
	** 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 5 (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.