0001209191-20-021345.txt : 20200326 0001209191-20-021345.hdr.sgml : 20200326 20200326191750 ACCESSION NUMBER: 0001209191-20-021345 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200324 FILED AS OF DATE: 20200326 DATE AS OF CHANGE: 20200326 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Zack Debra CENTRAL INDEX KEY: 0001807743 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39049 FILM NUMBER: 20747509 MAIL ADDRESS: STREET 1: C/O EXAGEN, INC. STREET 2: 1261 LIBERTY WAY, SUITE C CITY: VISTA STATE: CA ZIP: 92081 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 FISCAL YEAR END: 1231 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 2020-03-24 0 0001274737 EXAGEN INC. XGN 0001807743 Zack Debra C/O EXAGEN INC. 1261 LIBERTY WAY, SUITE C VISA CA 92081 0 1 0 0 Chief Medical Officer Stock Option (Right to Buy) 13.44 2020-03-24 4 A 0 100000 0.00 A 2030-03-23 Common Stock 100000 100000 D The option is exercisable as it vests. 25% of the shares subject to the option vest on March 24, 2021, 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, as attorney-in-fact 2020-03-26