0001209191-23-049321.txt : 20230913 0001209191-23-049321.hdr.sgml : 20230913 20230913174515 ACCESSION NUMBER: 0001209191-23-049321 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230911 FILED AS OF DATE: 20230913 DATE AS OF CHANGE: 20230913 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bellini Heather CENTRAL INDEX KEY: 0001845220 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40058 FILM NUMBER: 231253621 MAIL ADDRESS: STREET 1: 767 FIFTH AVENUE, 34TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10153 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Spectral AI, Inc. CENTRAL INDEX KEY: 0001833498 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2515 MCKINNEY AVE #1000 CITY: DALLAS STATE: TX ZIP: 75201 BUSINESS PHONE: (212) 492-3000 MAIL ADDRESS: STREET 1: 2515 MCKINNEY AVE #1000 CITY: DALLAS STATE: TX ZIP: 75201 FORMER COMPANY: FORMER CONFORMED NAME: Rosecliff Acquisition Corp I DATE OF NAME CHANGE: 20201123 4 1 doc4.xml FORM 4 SUBMISSION X0508 4 2023-09-11 1 0001833498 Spectral AI, Inc. MDAI 0001845220 Bellini Heather C/O ROSECLIFF ACQUISITION CORP I 767 5TH AVENUE, 34TH FLOOR NEW YORK NY 10153 1 0 0 0 0 Common Stock 2023-09-11 4 M 0 20000 0.00 A 20000 D Class B Common Stock 2023-09-11 4 M 0 20000 0.00 D Class A Common Stock 20000 0 D Pursuant to that certain Business Combination Agreement, dated as of April 11, 2023, by and among the Issuer, Ghost Merger Sub I Inc., a Delaware corporation and a wholly owned subsidiary of the Issuer, Ghost Merger Sub II LLC, a Delaware limited liability company and a wholly owned subsidiary of the Issuer, and Spectral MD Holdings, Ltd., a Delaware corporation, the Issuer consummated its initial business combination on September 11, 2023, whereby, among other things, each share of the Issuer's Class B common stock was converted into one share of the Issuer's Class A common stock, which was redesignated as common stock. Shares of the Issuer's Class B common stock were automatically convertible into shares of the Issuer's Class A common stock at the time of the Issuer's initial business combination, or earlier at the option of the holder, on a one-for-one basis, subject to certain adjustments, and had no expiration date. /s/ Michael Murphy, as attorney-in-fact for Heather Bellini 2023-09-13