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