0001209191-20-024575.txt : 20200415
0001209191-20-024575.hdr.sgml : 20200415
20200415203412
ACCESSION NUMBER: 0001209191-20-024575
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200413
FILED AS OF DATE: 20200415
DATE AS OF CHANGE: 20200415
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: 20794893
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
2020-04-13
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
2020-04-13
4
J
0
144033
0.00
D
0
I
See Footnote
Common Stock
2020-04-13
4
J
0
1185
0.00
A
1185
D
PCM/Exagen, L.P. (PCM) distributed 144,033 shares of Common Stock of the Issuer to its limited partners on a pro rata basis, for no consideration.
The shares reported on this form are held of record by PCM/Exgen, L.P. Ebetuel Palleres is co-manager of PCM. As a result, each of PCM and Dr. Palleres may be deemed to share beneficial ownership of the shares held of record by PCM.
Dr. Pallares received shares distributed by PCM on a pro rata basis for no consideration to its limited partners.
/s/ Kamal Adawi, as attorney-in-fact
2020-04-15