0001179110-19-010129.txt : 20190905 0001179110-19-010129.hdr.sgml : 20190905 20190905171335 ACCESSION NUMBER: 0001179110-19-010129 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190903 FILED AS OF DATE: 20190905 DATE AS OF CHANGE: 20190905 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Blackford Quentin S. CENTRAL INDEX KEY: 0001612451 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36046 FILM NUMBER: 191077926 MAIL ADDRESS: STREET 1: 7475 LUSK BLVD. CITY: SAN DIEGO STATE: CA ZIP: 92121 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 edgar.xml FORM 4 - X0306 4 2019-09-03 0 0000805928 Axogen, Inc. AXGN 0001612451 Blackford Quentin S. 13631 PROGRESS BLVD. SUITE 400 ALACHUA FL 32615 1 0 0 0 Stock Option (right to purchase) 15.44 2019-09-03 4 A 0 10710 0 A 2029-09-03 Common Stock 10710 10710 D Restricted Stock Units 2019-09-03 4 A 0 2591 0 A Common Stock 2591 2591 D 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 September 3, 2019, one year from the anniversary of the grant date. Two-thirds of the annual equity grant value is in the form of non-qualified stock options and one-third of the annual equity grant value is in the form of restricted stock units. Each restricted stock unit represents a contingent right to receive one share of Axogen, Inc. common stock. /s/ Quentin Blackford 2019-09-04