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Form 3 ZyVersa Therapeutics, For: Jan 26 Filed by: Guzman Pablo A.

January 26, 2023 8:23 PM EST
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 *
Guzman Pablo A.

(Last) (First) (Middle)
C/O ZYVERSA THERAPEUTICS, INC.
2200 N. COMMERCE PARKWAY, SUITE 208

(Street)
WESTON FL 33326

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/26/2023
3. Issuer Name and Ticker or Trading Symbol
ZyVersa Therapeutics, Inc. [ ZVSA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Medical Officer
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 26,021
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)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to Buy) 01/15/2015 01/14/2025 Common Stock 2,978 5.03 D  
Stock Option (Right to Buy)   (1) 04/08/2025 Common Stock 9,927 5.03 D  
Stock Option (Right to Buy)   (2) 04/01/2029 Common Stock 19,854 11.58 D  
Stock Option (Right to Buy) 10/31/2020 10/31/2030 Common Stock 11,019 16.36 D  
Stock Option (Right to Buy) 12/31/2020 12/31/2030 Common Stock 2,912 16.36 D  
Stock Option (Right to Buy) 03/31/2021 03/31/2031 Common Stock 4,368 16.36 D  
Stock Option (Right to Buy) 06/30/2021 06/30/2031 Common Stock 4,368 16.36 D  
Stock Option (Right to Buy) 09/30/2021 09/30/2031 Common Stock 4,368 16.36 D  
Stock Option (Right to Buy) 12/31/2021 12/31/2031 Common Stock 4,368 16.36 D  
Stock Option (Right to Buy) 03/31/2022 03/31/2032 Common Stock 4,368 16.36 D  
Stock Option (Right to Buy) 06/30/2022 06/30/2032 Common Stock 4,368 11.33 D  
Warrant (Right to Buy) 12/12/2022 12/12/2027 Common Stock 9,015 6.9 D  
Explanation of Responses:
1. 100% of the option is immediately exercisable. The option vested in 3 equal annual installments commencing on January 22, 2016.
2. 100% of the option is immediately exercisable. The option vested in 3 equal annual installments commencing on April 1, 2020.
Remarks:
Exhibit 24- Power of Attorney
/s/ Pablo Guzman 01/26/2023
** 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.

ATTACHMENTS / EXHIBITS

ex24.htm



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