0000950170-23-065608.txt : 20231121 0000950170-23-065608.hdr.sgml : 20231121 20231121172415 ACCESSION NUMBER: 0000950170-23-065608 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20231121 DATE AS OF CHANGE: 20231121 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: Carmell Corp CENTRAL INDEX KEY: 0001842939 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-92731 FILM NUMBER: 231429237 BUSINESS ADDRESS: STREET 1: 1177 AVENUE OF THE AMERICAS STREET 2: 5TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10036 BUSINESS PHONE: 646-494-3296 MAIL ADDRESS: STREET 1: 1177 AVENUE OF THE AMERICAS STREET 2: 5TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10036 FORMER COMPANY: FORMER CONFORMED NAME: Carmell Therapeutics Corp DATE OF NAME CHANGE: 20230727 FORMER COMPANY: FORMER CONFORMED NAME: ALPHA HEALTHCARE ACQUISITION CORP III DATE OF NAME CHANGE: 20210127 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: Shukla Rajiv CENTRAL INDEX KEY: 0001709033 FILING VALUES: FORM TYPE: SC 13G MAIL ADDRESS: STREET 1: EMERALD VIEW SUITE 400 STREET 2: 2054 VISTA PARKWAY CITY: WEST PALM BEACH STATE: FL ZIP: 33411 SC 13G 1 form_4_-_r_shukla_112122.htm SC 13G SC 13G

SEC Form 4

FORM 4

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

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

OMB APPROVAL

 

 

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

 

 

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
(Check all applicable)

 

X   Director X   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)

X Form 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

 

Common Stock

11/20/2023

11/22/2023

P

 

3,750

A

$2.6179 (2)

14,362

D

 

Common Stock

11/21/2023

11/24/2023

P

 

200

A

$2.4857

14,562

D

 

Common Stock

 

 

 

 

 

 

4,249,908

I

By AHAC Sponsor III LLC (3)

 

 

ACTIVE/126196759.1


 

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Explanation of Responses:

 

1.
The price reported in Column 4 is an average price. These shares were purchased in multiple transactions at prices ranging from $2.60 to $2.70, inclusive. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth in this footnote 1.
2.
The price reported in Column 4 is an average price. These shares were purchased in multiple transactions at prices ranging from $2.30 to $2.65, inclusive. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth in this footnote 2.
3.
AHAC Sponsor III LLC (the "Sponsor") is the record holder of these shares. The Reporting Person is the managing member of the Sponsor and may be deemed the beneficial owner of the shares held by the Sponsor. The Reporting Person disclaims beneficial ownership over any securities in which he does not have a pecuniary interest.

 

 

 

/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