Sec Form 4 Filing - Ehrlich Christopher B @ CERO THERAPEUTICS HOLDINGS, INC. - 2024-09-25

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Ehrlich Christopher B
2. Issuer Name and Ticker or Trading Symbol
CERO THERAPEUTICS HOLDINGS, INC. [ CERO]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Interim Chairman and CEO
(Last) (First) (Middle)
CERO THERAPEUTICS HOLDINGS, INC., 201 HASKINS WAY, SUITE 230
3. Date of Earliest Transaction (MM/DD/YY)
09/25/2024
(Street)
SOUTH SAN FRANCISCO, CA94080
4. If Amendment, Date Original Filed (MM/DD/YY)
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 (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 09/25/2024 M( 1 ) 5,312,983 A 5,791,808 D
Common Stock 3,600 I By Spouse
09/25/2024
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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 of Derivative Security: 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
Series A Convertible Preferred Stock ( 1 ) M( 1 ) 275 ( 1 ) ( 1 ) Common Stock 5,312,983 $ 1,000 0 D
Stock Option (Right to Buy) $ 1.77 09/30/2024 D( 2 ) 572,182 ( 2 ) 03/24/2034 Common Stock 572,182 $ 0 0 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Ehrlich Christopher B
CERO THERAPEUTICS HOLDINGS, INC.
201 HASKINS WAY, SUITE 230
SOUTH SAN FRANCISCO, CA94080
X Interim Chairman and CEO
Signatures
/s/ Christopher B. Ehrlich 10/02/2024
Signature of Reporting Person Date
Explanation of Responses:
( 1 )On September 25, 2024, the Reporting Person converted an aggregate of 275 shares of Series A Preferred Stock into 5,312,983 shares of Common Stock. Each share of Series A Preferred Stock has a stated value of $1,000 and, at the option of the holder, is convertible into a number of shares of Common Stock determined by dividing (x) the value of the shares of Series A Preferred Stock, plus any additional amounts thereon as of such date of determination, by (y) the conversion price of $1.00. As a result of various adjustments in the terms of the Series A Preferred Stock, each $1,000 of Series A Preferred Stock was converted into 19,320 shares of common stock. The Series A Preferred Stock has no expiration date.
( 2 )Represents the forfeiture of employee stock options in connection with the Reporting Person's appointment as Chief Executive Officer of the Issuer.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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