0001209191-20-021486.txt : 20200327 0001209191-20-021486.hdr.sgml : 20200327 20200327180717 ACCESSION NUMBER: 0001209191-20-021486 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200311 FILED AS OF DATE: 20200327 DATE AS OF CHANGE: 20200327 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PALLARES EBETUEL CENTRAL INDEX KEY: 0001614597 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39049 FILM NUMBER: 20753234 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 2020-03-11 0 0001274737 EXAGEN INC. XGN 0001614597 PALLARES EBETUEL C/O EXAGEN INC. 1261 LIBERTY WAY, SUITE C VISTA CA 92081 1 0 0 0 Common Stock 2020-03-11 4 M 0 22427 1.84 A 144094 I See footnote Common Stock 2020-03-11 4 F 0 2112 19.507 D 141982 I See footnote Common Stock 2020-03-11 4 M 0 2265 1.84 A 144247 I See footnote Common Stock 2020-03-11 4 F 0 214 19.507 D 144033 I See footnote Warrants 1.84 2020-03-11 4 M 0 22427 0.00 D Common Stock 22427 0 I See footnote Warrants 1.84 2020-03-11 4 M 0 2265 0.00 D Common Stock 2265 0 I See footnote The shares reported on this form are held of record by PCM/Exagen, L.P. ("PCM"). Ebetuel Pallares is a co-manager of PCM. As a result, each of PCM and Dr. Pallares may be deemed to share beneficial ownership of the shares held of record by PCM. Represents the cashless net exercise of a warrant through the surrender of shares to the Issuer based on a fair market value of $19.507 per share, as determined by the average closing price of the Issuer's common stock for the ten trading days immediately preceding the date of exercise. The warrants are currently exercisable and will expire on January 19, 2026. The warrants are currently exercisable and will expire on March 31, 2026. /s/ Kamal Adawi, as attorney-in-fact 2020-03-27