# EDGAR Filing Document

**Accession Number:** 0001410289
**File Stem:** 0001410289-25-000006
**Filing Date:** 2025-11
**Character Count:** 7393
**Document Hash:** e3d00185081aae77b4927ccfb6a9fd41
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001410289-25-000006.hdr.sgml**: 20251125

**ACCESSION NUMBER**: 0001410289-25-000006

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20240213

**FILED AS OF DATE**: 20251125

**DATE AS OF CHANGE**: 20251125

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Szela Mary T
- **CENTRAL INDEX KEY:** 0001410289

**ORGANIZATION NAME:**

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-39813
- **FILM NUMBER:** 251520639

**MAIL ADDRESS:**
- **STREET 1:** 10835 ROAD TO THE CURE
- **STREET 2:** SUITE 205
- **CITY:** SAN DIEGO
- **STATE:** CA
- **ZIP:** 92121
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** TriSalus Life Sciences, Inc.
- **CENTRAL INDEX KEY:** 0001826667
- **STANDARD INDUSTRIAL CLASSIFICATION:** SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
- **ORGANIZATION NAME:** 08 Industrial Applications and Services
- **EIN:** 853009869
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 6272 WEST 91ST AVENUE
- **CITY:** WESTMINSTER
- **STATE:** CO
- **ZIP:** 80031
- **BUSINESS PHONE:** 415 336 8917

**MAIL ADDRESS:**
- **STREET 1:** 6272 WEST 91ST AVENUE
- **CITY:** WESTMINSTER
- **STATE:** CO
- **ZIP:** 80031

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** MedTech Acquisition Corp
- **DATE OF NAME CHANGE:** 20200930

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Szela Mary T<br><sub>(Last) (First) (Middle)</sub><br>6272 W. 91ST AVENUE<br><sub>(Street)</sub><br>WESTMINSTER, CO 80031<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2024-02-13 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [ ] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_CEO and President_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>TriSalus Life Sciences, Inc. [ TLSI ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common Stock | 2024-02-13 |  | A |  | 125000<sup>(1)</sup> | A | $0 | 317802 | D |  |
| Common Stock | 2025-11-24 |  | A |  | 125000<sup>(2)</sup> | A | $0 | 442802 | D |  |
| Common Stock | 2025-11-24 |  | A |  | 300000<sup>(3)</sup> | A | $0 | 742802 | D |  |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Employee Stock Option (right to buy) | $5.55 | 2025-11-24 |  | A |  | 250000 |  | <sup>(4)</sup> | 2035-11-23 | Common Stock | 250000 | $0 | 1578182 | D |  |

---

### Footnotes:

(1) Represents the granting of Performance Stock Units (PSUs) upon achieving or exceeding $50 million of revenue over any 12 consecutive calendar month period ending on or before February 28, 2027. The PSUs vest immediately upon achieving the performance requirement, subject to the continued employment through each respective vesting date.

(2) Represents grant of restricted stock units (the "RSU Award") payable solely in common stock of the Issuer. The shares subject to the RSU Award vest in four equal annual installments commencing on November 24, 2025, subject to continued employment through the respective vesting date.

(3) Represents the granting of PSUs upon achieving or exceeding $75 million of revenue over any 12 consecutive calendar month period ending on or before December 31, 2027. 150,000 PSUs vest immediately upon achieving the performance requirement and 150,000 PSUs vest on the one-year anniversary of achieving the performance requirement, subject to the continued employment through each respective vesting date.

(4) One-fourth (1/4th) of the shares subject to the option shall vest on the one-year anniversary of the vesting commencement date of November 24, 2025 (the "VCD"), and 1/36th of the remaining sharesshall vest each month thereafter on the same day of the month as the VCD (or if there is no corresponding day, on the last day of the month), subject to continued employment through the respective vesting date.

**Signature:** /s/ Mary Szela  
**Date:** 2025-11-25

### Remarks:

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.**