0001209191-22-046168.txt : 20220817 0001209191-22-046168.hdr.sgml : 20220817 20220817124710 ACCESSION NUMBER: 0001209191-22-046168 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20220815 FILED AS OF DATE: 20220817 DATE AS OF CHANGE: 20220817 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: THOMAS PAUL CENTRAL INDEX KEY: 0001166776 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38832 FILM NUMBER: 221172817 MAIL ADDRESS: STREET 1: ONE MILLENNIUM WAY CITY: BRANCHBURG STATE: NJ ZIP: 08876 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2022-08-15 0 0001760173 SURGALIGN HOLDINGS, INC. SRGA 0001166776 THOMAS PAUL 520 LAKE COOK ROAD SUITE 315 DEERFIELD IL 60015 1 0 0 0 Common Stock 2022-08-15 4 A 0 22857 0.00 A 28610 D Represents shares of restricted stock of Surgalign Holdings, Inc. (the "Company") granted as part of the director compensation program of the Company, all of which will vest on the first anniversary of the date of grant. The total shares reported reflect 1:30 reverse stock split on May 17, 2022. By Jessica Rumschlag as attorney in fact 2022-08-17 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 16th day of May, 2022. /P. Thomas/_____ Signature Paul Thomas_____ Print Name State of New Jersey County of Somerset This instrument was acknowledged before me on this 16th day of May, 2022 by Paul G. Thomas. /Gopiben Patel/ Signature of Notary My commission expires: April 03, 2027 My commission #: 50057994