Statement of Changes in Beneficial Ownership (4)
24 June 2022 - 6:07AM
Edgar (US Regulatory)
FORM 4
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
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Mills C Randal |
2. Issuer Name and Ticker or Trading Symbol
AZIYO BIOLOGICS, INC.
[
AZYO
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
Interim President and CEO |
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(Last)
(First)
(Middle)
C/O AZIYO BIOLOGICS, INC., 12510 PROSPERITY DRIVE, SUITE 370 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/21/2022 |
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(Street)
SILVER SPRING, MD 20904
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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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 |
| Stock Option (Right to Buy) | $6.39 | 6/21/2022 | | A | | 273767 | | (1) | 6/20/2032 | Class A Common Stock | 273767 | $0 | 273767 | D | |
| Stock Option (Right to Buy) | $6.39 | 6/21/2022 | | A | | 182511 | | (2) | 6/20/2032 | Class A Common Stock | 182511 | $0 | 182511 | D | |
| Explanation of Responses: |
| (1) | The option vests and becomes exercisable as to one-third of the underlying shares upon the day following the expiration of the Interim Period (as defined in the Reporting Person's Employment Agreement dated June 21, 2022). The remaining two-thirds of the underlying shares vest and become exercisable, with respect to 25% of such shares, on June 21, 2023, and, with respect to 75% of such shares, in twelve equal quarterly installments thereafter, beginning on September 21, 2023, subject to the Reporting Person's continuous employment with the Issuer through the applicable vesting date. |
| (2) | The option vests and becomes exercisable in four equal installments upon the Issuer's achievement of a share price equal to or greater than $12.50, $17.00, $25.00 and $37.00, in each case determined based on twenty consecutive days of trading at or above the applicable threshold, subject to the Reporting Person's continuous employment with the Issuer through the applicable vesting date. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Mills C Randal
C/O AZIYO BIOLOGICS, INC.
12510 PROSPERITY DRIVE, SUITE 370
SILVER SPRING, MD 20904 | X |
| Interim President and CEO |
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Signatures
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| /s/ Jeffrey Hamet, Attorney-in-Fact for C Randal Mills | | 6/23/2022 |
| **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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