SEC Form 4 · accession 0001209191-15-079884
Axogen, Inc. · AXGN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Mark Stephen Gold
Director
Period of report
Nov 12, 2015
Accepted (ET)
Nov 12, 2015 · 6:55 pm EST
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 | Nov 12, 2015 | M | 11,250 | $3.60 | A | 321,498 | 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 | Nov 12, 2015 | M | 11,250 | D | Apr 2, 2015 | Jan 2, 2022 | Common Stock | 15,000 | 18,750 | D |
Explanation of responses
- F1The shares 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.