SEC Form 4 · accession 0001437749-15-000093
COGENTIX MEDICAL INC /DE/ · CGNT
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Lewis C Pell
Director · 10% Owner
Period of report
Dec 30, 2014
Accepted (ET)
Jan 2, 2015 · 4:59 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000894237
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Convertible Promissory Note | $1.11 | Dec 30, 2014 | J | — | A | Dec 30, 2014 | Jun 16, 2019 | common stock | 900,900 | 26,083,473 | D |
Explanation of responses
- F1The Issuer issued a $5.0 million revolving convertible promissory note to the Reporting Person on June 16, 2014 (the "2014 Note"). On December 30, 2014, the Issuer borrowed an additional $1.0 million under the Note, bring the aggregate principal amount outstanding under the Note to $4.0 million. The Note is convertible, at the Reporting Person's option, into shares of the Issuer's common stock at a fixed conversion price of $1.11 per share.