Statement of Changes in Beneficial Ownership (4)
19 March 2022 - 07:13AM
Edgar (US Regulatory)
FORM 4
[ ] Check this box if no longer subject to Section
16. Form 4 or Form 5 obligations may continue. See
Instruction 1(b).
|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
|
OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response... 0.5 |
|
Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934 or Section 30(h) of the Investment
Company Act of 1940
|
|
1. Name
and Address of Reporting Person *
Zaderej Karen L. |
2. Issuer Name and Ticker or Trading
Symbol Axogen, Inc. [ AXGN ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
CEO |
(Last)
(First)
(Middle)
13631 PROGRESS BOULEVARD, SUITE 400 |
3. Date of Earliest Transaction (MM/DD/YYYY)
3/16/2022
|
(Street)
ALACHUA, FL 32615
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
6. Individual or Joint/Group Filing
(Check Applicable Line) _X _ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
3/16/2022 |
|
M |
|
25950 (1) |
A |
$0 |
966333 |
D |
|
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. Code
(Instr. 8) |
5. Number of Derivative Securities Acquired (A) or
Disposed of (D)
(Instr. 3, 4 and 5) |
6. Date Exercisable and Expiration Date |
7. Title and Amount of Securities Underlying
Derivative Security
(Instr. 3 and 4) |
8. Price of Derivative Security
(Instr. 5) |
9. Number of derivative Securities Beneficially
Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Restricted Stock Units |
(2) |
3/16/2022 |
|
M |
|
|
25950 |
(3) |
(3) |
Common Stock |
25950.0 |
$0 |
25950 |
D |
|
Restricted Stock Units |
(2) |
3/16/2022 |
|
A |
|
169694 |
|
(4) |
(4) |
Common Stock |
169694.0 |
$0 |
169694 |
D |
|
Employee Stock Option (right to
purchase) |
$10.25 (5) |
3/16/2022 |
|
A |
|
317185 |
|
(6) |
3/16/2032 |
Common Stock |
317185.0 |
$0 |
317185 |
D |
|
Explanation of
Responses: |
(1) |
This reflects the number of
restricted stock units that became vested as of March 16,
2022. |
(2) |
Each restricted stock unit
represents a contingent right to receive one share of Axogen, Inc.
common stock. |
(3) |
All shares of Axogen Inc.
common stock underlying the restricted stock units will be fully
vested on March 16, 2024 (4 years from the grant date) based upon a
vesting schedule whereby 50% of the aggregate shares vest on March
16, 2022 (24 months from the grant date) and an additional 25% of
the aggregate shares vest each 12 months thereafter. Vested shares
will be delivered to the reporting person upon the vesting
date. |
(4) |
All shares of Axogen Inc.
common stock underlying the restricted stock units will be fully
vested on March 16, 2026 (4 years from the grant date) based upon a
vesting schedule whereby 50% of the aggregateshares vest on March
16, 2024 (24 months from the grant date) and an additional 25% of
the aggregate shares vest each 12 months thereafter. Vested shares
will be delivered to the reporting person upon the vesting
date. |
(5) |
The exercise price of $10.25
represents a 25% premium over the fair market value of Axogen
common stock on the date of the grant. |
(6) |
All shares of Axogen, Inc.
common stock underlying the employee stock option will be fully
vested on March 16, 2026 (4 years from the option grant date) based
upon a vesting schedule whereby 25% of the aggregate shares vest on
March 16, 2023 and on each anniversary thereafter. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Zaderej Karen L.
13631 PROGRESS BOULEVARD
SUITE 400
ALACHUA, FL 32615 |
X |
|
CEO |
|
Signatures
|
/s/ Karen Zaderej |
|
3/18/2022 |
**Signature of
Reporting Person |
Date |
Reminder: Report on a separate line for each class
of securities beneficially owned directly or
indirectly. |
* |
If the form is filed by more than one
reporting person, see Instruction 4(b)(v). |
** |
Intentional misstatements or omissions
of facts constitute Federal Criminal Violations. See 18
U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: |
File three copies of this Form, one of
which must be manually signed. If space is insufficient, see
Instruction 6 for procedure. |
Persons who respond to the collection of information
contained in this form are not required to respond unless the form
displays a currently valid OMB control number. |
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