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 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 02/08/2008 |
3. Issuer Name and Ticker or Trading Symbol
MIMEDX GROUP, INC. [ MDXG.OB ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) 02/14/2008 |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 | ||||
Stock Option | (1) | 12/12/2015 | Common Stock | 100,000(3) | 1.8(2)(3) | D | |
Stock Option | (4) | 12/14/2016 | Common Stock | 50,000(3) | 1.8(3)(5) | D |
Explanation of Responses: |
1. 50% of the option vested on the date of grant, December 13, 2005; 25% vested on September 1, 2007; and the final 25% vested on September 1, 2008. The vesting schedule was previously reported incorrectly due to a clerical error. |
2. Received in exchange for a stock option to acquire 100,000 shares of MiMedx, Inc. common stock for $1.80 per share in connection with the merger of MiMedx, Inc. with and into MMX Acquisition Corp., a wholly-owned subsidiary of MiMedx Group, Inc. |
3. The information contained in this report reflects a 0.3234758-for-1 reverse stock split that occurred on March 31, 2008. |
4. 25% of the option vested on the date of grant, December 15, 2006, with an additional 25% vesting in equal installments on each of March 31 of 2008, 2009, and 2010. Options for 25,000 shares are currently exercisable. The vesting schedule was previously reported incorrectly due to a clerical error. |
5. Received in exchange for a stock option to acquire 50,000 shares of MiMedx, Inc. common stock for $1.80 per share in connection with the merger of MiMedx, Inc. with and into MMX Acquisition Corp., a wholly-owned subsidiary of MiMedx Group, Inc. |
Remarks: |
/s/ V. Nicole Teal, pursuant to a POA filed previously with the SEC | 09/18/2008 | |
** 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. |