Ownership Submission
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FORM 4
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Check this box if no longer subject to Section 16, Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549STATEMENT OF CHANGES IN 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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OMB APPROVAL
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OMB Number:3235-0287Expires:January 31, 2005Estimated average burden hours per response...0.5
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1. Name and Address of Reporting Person *
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Rodgers Thurman J
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2. Issuer Name and Ticker or Trading Symbol
Complete Solaria, Inc. [CLSR]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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__X__ Director
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_____ 10% Owner
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_____ Officer (give title below)
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_____ Other (specify below)
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Chief Executive officer /
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(Last)
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(First)
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(Middle)
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C/O COMPLETE SOLARIA, INC. , 45700 NORTHPORT LOOP EAST
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3. Date of Earliest Transaction (Month/Day/Year)
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(Street)
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FREEMONT
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CA
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94538
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4. If Amendment, Date Original Filed(Month/Day/Year)
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6. Individual or Join/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
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2. Transaction Date (Month/Day/Year)
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2A. Deemed Execution Date, if any (Month/Day/Year)
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3. Transaction Code
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4. Securities Acquired (A) or Disposed of (D)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
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6. Ownership Form: Direct (D) or Indirect (I)
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7. Nature of Indirect Beneficial Ownership
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
(e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date (Month/Day/Year)
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3A. Deemed Execution Date, if any (Month/Day/Year)
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4. Transaction Code
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
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8. Price of Derivative Security
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
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11. Nature of Indirect Beneficial Ownership
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expriation Date
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Title
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Amount or Number of Shares
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Rodgers Thurman J
C/O COMPLETE SOLARIA, INC.
45700 NORTHPORT LOOP EAST
FREEMONT, CA94538
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X
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X
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Chief Executive officer
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Signatures
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/s/ Michael Penney, Attorney-in-Fact for Thurman J. Rodgers
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2024-09-23
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**Signature of Reporting Person
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Date
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Explanation of Responses:
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(*)
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If the form is filed by more than one reporting person, see Instruction 5(b)(v).
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(**)
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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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(1)
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The conversion rate for the 7% Convertible Senior Notes due 2029 (the "Convertible Notes") is equal to 467.8363 shares of common stock per $1,000 principal amount of the Convertible Notes (equivalent to an initial conversion price of approximately $2.14 per share of common stock), subject to adjustment in accordance with the applicable indenture.
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(2)
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The Convertible Notes mature on July 1, 2029, unless earlier converted or repurchased. The Reporting Person may convert all or any portion of the Convertible Notes at any time after September 16, 2025 and prior to the close of business on the business day immediately preceding the maturity date.
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(3)
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$4,000,000 of the Convertible Notes are owned by the Rodgers Massey Revocable Trust, for which the Reporting Person and his spouse serve as trustee. $4,000,000 of the remaining Convertible Notes are owned by the Rodgers Family Freedom and Free Markets Charitable Trust, for which the Reporting Person and his spouse serve as trustee.
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Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
See Instruction 6 for procedure.Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
