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
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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).
1. Name and Address of Reporting Person*
Van Heel Kenneth

(Last) (First) (Middle)
C/O SEASTAR MEDICAL HOLDING CORPORATION
3513 BRIGHTON BLVD., SUITE 410

(Street)
DENVER CO 80216

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
SeaStar Medical Holding Corp [ ICU ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
10/28/2022
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
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, par value $0.0001 per share 10/28/2022 A(1) 8,422 A $0.00 8,422 D
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
Stock Option (Right to Buy) $0.55 10/28/2022 A(2) 24,483 (3) 10/14/2031 Common Stock 24,483 $0.00 24,483 D
Explanation of Responses:
1. Represents the Issuer's common stock subject to restricted stock units (RSUs). Pursuant to the Agreement and Plan of Merger by and among the Issuer, LMF Merger Sub, Inc., and SeaStar Medical Inc. ("SeaStar Medical"), dated April 21, 2022 (as amended, the "Merger Agreement"), at the Effective Time (as defined in the Merger Agreement), each award of RSUs based on SeaStar Medical common stock that was outstanding immediately prior to the Effective Time was converted into the right to receive RSUs based on the common stock of the Issuer with the same terms and conditions as were applicable to such SeaStar Medical RSU awards immediately prior to the Effective Time, subject to the applicable exchange ratio. Fifty percent (50%) of the shares subject to RSUs reported herein will vest on the first anniversary of the Effective Time, thereafter the remaining will vest on a monthly basis over a 12-month period.
2. Pursuant to the Merger Agreement, at the Effective Time, each outstanding option to purchase shares of SeaStar Medical common stock was assumed and converted into an option to purchase shares of common stock of the Issuer with the same terms and conditions as were applicable to such option immediately prior to the Effective Time, subject to the applicable exchange ratio.
3. The option vests with respect to (i) twenty-five percent (25%) of the shares upon completion of one (1) year of service measured from October 14, 2021 and (ii) the balance of the shares subject to the option in a series of thirty-six (36) successive equal monthly installments upon completion of each additional month of service over the thirty-six (36)-month period measured from October 14, 2022.
Remarks:
/s/ Kenneth Van Heel 11/01/2022
** 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.
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