0000805928-22-000063.txt : 20220603 0000805928-22-000063.hdr.sgml : 20220603 20220603160741 ACCESSION NUMBER: 0000805928-22-000063 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220601 FILED AS OF DATE: 20220603 DATE AS OF CHANGE: 20220603 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Gold Mark Stephen CENTRAL INDEX KEY: 0001531332 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36046 FILM NUMBER: 22994401 MAIL ADDRESS: STREET 1: 13859 PROGRESS BLVD SUITE 100 CITY: ALACHUA STATE: FL ZIP: 32615 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Axogen, Inc. CENTRAL INDEX KEY: 0000805928 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 411301878 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 13631 PROGRESS BLVD. STREET 2: SUITE 400 CITY: ALACHUA STATE: FL ZIP: 32615 BUSINESS PHONE: (386) 462-6817 MAIL ADDRESS: STREET 1: 13631 PROGRESS BLVD. STREET 2: SUITE 400 CITY: ALACHUA STATE: FL ZIP: 32615 FORMER COMPANY: FORMER CONFORMED NAME: AxoGen, Inc. DATE OF NAME CHANGE: 20111004 FORMER COMPANY: FORMER CONFORMED NAME: LECTEC CORP /MN/ DATE OF NAME CHANGE: 19920703 4 1 wf-form4_165428683027747.xml FORM 4 X0306 4 2022-06-01 0 0000805928 Axogen, Inc. AXGN 0001531332 Gold Mark Stephen 13631 PROGRESS BOULEVARD SUITE 400 ALACHUA FL 32615 1 0 0 0 Common Stock 2022-06-01 4 M 0 3036 0 A 305475 D Restricted Stock Units 2022-06-01 4 M 0 3036 0 D Common Stock 3036.0 0 D Restricted Stock Units 2022-06-01 4 A 0 6459 0 A Common Stock 6459.0 6459 D Stock Option (right to purchase) 9.29 2022-06-01 4 A 0 11811 0 A 2032-06-01 Common Stock 11811.0 11811 D This reflects the number of restricted stock units that vested on June 1, 2022. The shares of common stock for Dr. Gold include 31,900 shares held directly, 159,575 shares held jointly by Dr. Gold and his wife, indirect ownership of 22,000 shares held by Dr. Gold's spouse in revocable trusts, and indirect ownership of 92,000 shares held by MJSK, Ltd., a decedent investment trust. Each restricted stock unit represents a contingent right to receive one share of Axogen, Inc. common stock. Annual equity grant for service as Director on the Axogen, Inc. Board of Directors. The number of shares pursuant to the equity grant is based on a $120,000 valuation as of the grant date and vests on June 1, 2022, one year from the anniversary of the grant date. Annual equity grant for service as Director on the Axogen, Inc. Board of Directors. The number of shares pursuant to the equity grant is based on a $120,000 valuation as of the grant date and vests on June 1, 2023, one year anniversary of the grant date. One-half of the annual equity grant value is in the form of non-qualified stock options and one-half of the annual equity grant value is in the form of restricted stock units. /s/Dr. Mark Gold 2022-06-03