SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Rosellini Family Irrv Tr 2

(Last) (First) (Middle)
425 CARR 693 ST. 1 PMB 220

(Street)
DORADO PR 00646

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/08/2019
3. Issuer Name and Ticker or Trading Symbol
NEXEON MEDSYSTEMS INC [ NXNN ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 402,785 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
1. Name and Address of Reporting Person*
Rosellini Family Irrv Tr 2

(Last) (First) (Middle)
425 CARR 693 ST. 1 PMB 220

(Street)
DORADO PR 00646

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Price Jack

(Last) (First) (Middle)
604 EAST 4TH STREET, SUITE 200

(Street)
FORT WORTH TX 76102

(City) (State) (Zip)
Explanation of Responses:
Remarks:
Jack Price is the trustee of Rosellini Family Irrv Tr 2 (the "Trust") and has voting and dispositive power over the securities held by the Trust.
/s/ Jack Price, Trustee of Rosellini Family Irrv Tr 2 01/15/2019
/s/ Jack Price 01/15/2019
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.