SEC FORM 3/A SEC Form 3
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*
Hackman Jeffrey S.

(Last) (First) (Middle)
C/O COMERA LIFE SCIENCES HOLDINGS, INC.
12 GILL STREET, SUITE 4650

(Street)
WOBURN MA 01801

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/19/2022
3. Issuer Name and Ticker or Trading Symbol
Comera Life Sciences Holdings, Inc. [ CMRA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
See Remarks
5. If Amendment, Date of Original Filed (Month/Day/Year)
05/20/2022
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)
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)(1) (2) 09/16/2031 Common Stock 277,598 0.59 D
Explanation of Responses:
1. This Form 3/A is being filed to correct information previously disclosed on the original Form 3 filed by the reporting person on May 20, 2022, including the Exercise Price, Expiration Date, Amount or Number of Shares and vesting schedule of the stock option grant.
2. This option was issued pursuant to the terms of a business combination agreement involving the issuer and Comera Life Sciences, Inc. in exchange for a comparable option previously issued by such company on September 16, 2021. 25% of the option vests or vested on the one year anniversary of the grant date and in equal monthly installments thereafter for 36 months.
Remarks:
Chairman, President and Chief Executive Officer.
/s/ Ryan M. Rourke Reed, Attorney-in-Fact 02/14/2023
** 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 5 (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).
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