SEC Form 4 · accession 0001179110-16-028845
Axogen, Inc. · AXGN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Mark Stephen Gold
Director
Period of report
Aug 17, 2016
Accepted (ET)
Aug 19, 2016 · 3:25 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000805928
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Aug 17, 2016 | M | 3,750 | $3.60 | A | 325,248 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (right to purchase) | $3.60 | Aug 17, 2016 | M | 3,750 | D | Dec 31, 2015 | Jan 2, 2022 | Common Stock | 3,750 | 30,000 | D |
Explanation of responses
- F1The shares of common stock for Dr. Gold include 179,011 shares held jointly by Dr. Gold and his wife, indirect ownership of 20,000 shares held by Dr. Gold's spouse and indirect ownership of 122,487 shares held by MJSK, Ltd., a decedent investment trust held by Dr. Gold's family.