SEC Form 4 · accession 0001076542-17-000083
NEXEON MEDSYSTEMS INC · NXNN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Elizabeth Rosellini
Other
Period of report
Dec 31, 2016
Accepted (ET)
Oct 4, 2017 · 12:58 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001416172
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Jun 23, 2017 | G | 285,800 | $0.00 | D | 1,514,200 | D | |
| Common StockF1 | Jun 23, 2017 | J | 81,035 | — | D | 1,433,165 | D | |
| Common StockF1 | Jun 23, 2017 | J | 123,000 | — | D | 1,310,165 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| OptionsF2 | $1.00 | Dec 31, 2016 | J | 252,000 | D | — | — | Common Stock | 252,000 | 0 | D |
Explanation of responses
- F1On June 23, 2017, Dr. Rosellini transferred a total of 489,835 shares of common stock of the Company in the following private transactions: (a) gifted a total of 285,800 shares, (b) transferred 81,035 shares to Rosellini Scientific LLC pursuant to a loan agreement in the amount of $83,035, and (c) converted $123,000 in debt by the transfer of 123,000 shares.
- F2On April 1, 2016, Dr. Rosellini was issued nonqualified options to purchase 252,000 shares of the Company's common stock. On December 31, 2016, the 252,000 options were cancelled when Dr. Rosellini resigned her position with the Company.