Filing Details

Accession Number:
0000899243-19-024078
Form Type:
4
Zero Holdings:
No
Publication Time:
2019-09-23 21:43:23
Reporting Period:
2019-09-23
Accepted Time:
2019-09-23 21:43:23
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1274737 Exagen Inc. XGN () 4
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1050045 Anthony Tamer 1450 Brickell Avenue, 31St Floor
Miami FL 33131
No No Yes No
1050046 Sami Mnaymneh 1450 Brickell Avenue, 31St Floor
Miami FL 33131
No No Yes No
1788396 H.i.g. Bio-Exagen, L.p. 1450 Brickell Avenue, 31St Floor
Miami FL 33131
No No Yes No
1788482 H.i.g.-Gpii, Inc. 1450 Brickell Avenue, 31St Floor
Miami FL 33131
No No 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 2019-09-23 1,271,252 $0.00 1,271,252 No 4 C Indirect See footnote
Common Stock Acquisiton 2019-09-23 425,000 $14.00 1,696,252 No 4 P Indirect See footnote
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 C Indirect See footnote
No 4 P Indirect See footnote
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Common Stock Series H Redeemable Convertible Preferred Stock Disposition 2019-09-23 233,446,519 $0.00 1,271,252 $0.00
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
0 No 4 C Indirect
Footnotes
  1. The shares reported on this form are held of record by H.I.G. Bio-Exagen, L.P. ("H.I.G."). H.I.G.-GPII, Inc. ("H.I.G. GP") is the general partner of H.I.G. and has sole voting and investment control over the shares owned by H.I.G. Anthony Tamer and Sami Mnaymneh are the sole shareholders of H.I.G. GP and may be deemed to share beneficial ownership of the shares held by H.I.G. Bio-Exagen, L.P. Each of Mr. Tamer and Mr. Mnaymneh disclaims beneficial ownership of the shares reported herein except to the extent of their pecuniary interest, if any.
  2. The Series H Redeemable Convertible Preferred Stock ("Series H") is convertible into the Issuer's Common Stock on a 183.635-for-one basis at the holder's election and has no expiration date. The Series H automatically converted into Common Stock upon the closing of the Issuer's initial public offering.