UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF 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 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock option | Â (1) | 12/12/2015 | Common Stock | 80,000 (3) | $ 1.8 (2) (3) | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
BENNETT RUFUS LEWIS SR C/O MIMEDX, INC. 1234 AIRPORT RD., STE. 105 DESTIN, FL 32541 |
 |  |  President of Subsidiary |  |
/s/ V. Nicole Teal, pursuant to a POA filed previously with the SEC | 06/06/2008 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | The option vests in four equal annual installments, with the final installment vesting on December 13, 2008. Options for 60,000 shares are currently exercisable. |
(2) | Received in exchange for a stock option to acquire 80,000 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 Alynx, Co. (now MiMedx Group, Inc.). Due to a clerical error, the exercise price was previously reported incorrectly. |
(3) | The information contained in this report reflects a 0.3234758-for-1 reverse stock split that occurred on March 31, 2008. |