SEC Form 4 · accession 0001179110-18-008099
Axogen, Inc. · AXGN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Mark Stephen Gold
Director
Period of report
Nov 13, 2017
Accepted (ET)
Jun 5, 2018 · 5:02 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 | Jun 1, 2018 | M | 15,000 | $14.85 | A | 375,248 | 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) | $14.85 | Jun 1, 2018 | M | 15,000 | D | May 14, 2018 | Jun 1, 2027 | Common Stock | 15,000 | 0 | D |
| Stock Option (right to purchase)F2 | $49.65 | Jun 1, 2018 | A | 4,780 | A | — | Jun 1, 2028 | Common Stock | 4,780 | 4,780 | D |
Explanation of responses
- F1The shares of common stock for Dr. Gold include 212,761 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.
- F2Non-qualified stock option grant for service as Director on the Company's Board of directors. Options vest in equal installments every three months for the first nine months, with the finalinstallment vesting on the earlier of the date of the 2019 annual shareholders meeting or May 31, 2019. Number of shares pursuant to option are based on $120,000 valuation as of the grantdate.