Filing Details

Accession Number:
0001140361-11-000945
Form Type:
4
Zero Holdings:
No
Publication Time:
2011-01-04 17:38:35
Reporting Period:
2010-12-31
Filing Date:
2011-01-04
Accepted Time:
2011-01-04 17:38:35
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1376339 Mimedx Group Inc. MDXG Surgical & Medical Instruments & Apparatus (3841) 900300868
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
901434 H Parker Petit C/O Mimedx Group, Inc.
811 Livingston Court, Suite B
Marietta GA 30067
Chief Executive Officer No Yes Yes No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Common Stock Acquisiton 2010-11-15 600,000 $1.00 3,630,258 No 4 P Direct
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 P Direct
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Common Stock 5% Convertible Promissory Note Acquisiton 2010-10-20 150,000 $0.00 150,000 $1.00
Common Stock Warrant Acquisiton 2010-10-20 150,000 $1.00 150,000 $1.00
Common Stock 5% Convertible Promissory Note Acquisiton 2010-11-04 250,000 $0.00 250,000 $1.00
Common Stock Warrant Acquisiton 2010-11-04 250,000 $1.00 250,000 $1.00
Common Stock Warrant Disposition 2010-12-31 280,000 $0.60 280,000 $0.60
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
3,066,666 2010-10-21 2010-12-31 No 4 P Direct
3,216,666 2011-01-01 2013-10-20 No 4 P Direct
3,466,666 2010-11-05 2010-12-31 No 4 P Direct
3,716,666 2011-01-01 2013-11-04 No 4 P Direct
3,736,666 2009-12-21 2012-09-22 No 4 G Direct
Reported Derivative Holdings
Sec. Name Sec. Type Price Date Expiration Date Amount Remaning Holdings Nature of Ownership
Common Stock Warrant $1.50 2011-01-01 2015-11-15 300,000 4,016,666 Direct
Expiration Date Amount Remaning Holdings Nature of Ownership
2015-11-15 300,000 4,016,666 Direct
Footnotes
  1. Number of shares held directly by Mr. Petit. Mr. Petit also beneficially owns 150,000 shares held by the Parker H. Petit Grantor Trust, of which he serves as the Trustee; 150,000 shares held by Petit Investments LP of which he serves as General Partner and Limited Partner and possesses shared voting and investment control; and 975,000 shares held by Cox Road Partners II LLP, 975,000 shares held by Cox Road Partners LLLP, and 975,000 shares held by Petit Investments LLLP II, limited liability limited partnerships over which Mr. Petit possesses sole voting and investment control.
  2. In conjunction with the 5% Convertible Promissory Note, the holder was issued warrants to purchase common stock.
  3. In conjunction with the purchase of common stock listed in table 1 above, the holder was issued warrants to purchase common stock.