|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
|
|
|||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
| 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 control number. | SEC 1474 (9-02) | ||
|
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) |
4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
||||
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Series B Preferred Stock, par value $0.001 per share | $ 3.85 | 12/22/2023 | C | 90,000 | (1) | (1) | Common Stock | 28,195,249 | (1) | 0 (1) | D | ||||
| Reporting Owner Name / Address | Relationships | |||
| Director | 10% Owner | Officer | Other | |
| Falcon Fund 2 Holding Company, L.P. 21 WATERWAY AVENUE, SUITE 225 THE WOODLANDS, TX 77380 |
X | |||
| Falcon Fund 2 Holding Company, L.P., a Delaware limited partnership; By: EW Healthcare Partners Fund 2-UGP, LLC, its general partner; By: Martin P. Sutter, Authorized Signatory /s/ Martin P. Sutter | 12/27/2023 | |
| **Signature of Reporting Person | Date |
| * | If the form is filed by more than one reporting person, see Instruction 4(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). |
| (1) | On December 22, 2023, all 90,000 shares of Series B Preferred Stock, par value $0.001 per share, with a liquidation preference of $1,000.00 per share ("Series B Preferred Stock"), of MiMedx Group, Inc. (the "Issuer") held by Falcon Fund 2 Holding Company, L.P. (the "Reporting Person"), which were previously acquired by the Reporting Person on June 30, 2020, mandatorily converted into an aggregate 28,195,249 shares of common stock, par value $0.001 per share ("Common Stock"), of the Issuer, in accordance with the terms of the Series B Preferred Stock, which amount is inclusive of 4,818,626 shares of Common Stock issuable to the Reporting Person as a dividend. |