0000899243-19-024016.txt : 20190920 0000899243-19-024016.hdr.sgml : 20190920 20190920185839 ACCESSION NUMBER: 0000899243-19-024016 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190918 FILED AS OF DATE: 20190920 DATE AS OF CHANGE: 20190920 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Adawi Kamal CENTRAL INDEX KEY: 0001788393 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39049 FILM NUMBER: 191105863 MAIL ADDRESS: STREET 1: C/O EXAGEN INC. STREET 2: 1261 LIBERTY WAY, SUITE C CITY: VISTA STATE: CA ZIP: 92131 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: EXAGEN INC. CENTRAL INDEX KEY: 0001274737 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE BUSINESS ADDRESS: STREET 1: 1261 LIBERTY WAY CITY: VISTA STATE: CA ZIP: 92081 BUSINESS PHONE: (760) 560-1501 MAIL ADDRESS: STREET 1: 1261 LIBERTY WAY CITY: VISTA STATE: CA ZIP: 92081 FORMER COMPANY: FORMER CONFORMED NAME: EXAGEN DIAGNOSTICS INC DATE OF NAME CHANGE: 20031230 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2019-09-18 0 0001274737 EXAGEN INC. XGN 0001788393 Adawi Kamal C/O EXAGEN INC. 1261 LIBERTY WAY, SUITE C SAN DIEGO CA 92081 0 1 0 0 Chief Financial Officer Stock Option (right to buy) 14.00 2019-09-18 4 A 0 21635 0.00 A 2029-09-17 Common Stock 21635 21635 D The option is exercisable as it vests. 25% of the shares subject to the option vest on September 18, 2020, and 1/48th of the total number of shares subject to the option vest monthly thereafter, subject to the Reporting Person's continued service to the Issuer through each such vesting date. /s/ Kamal Adawi 2019-09-20