Initial Statement of Beneficial Ownership (3)
September 02 2015 - 4:50PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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Essex Woodlands Fund IX, L.P.
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2. Date of Event Requiring Statement (MM/DD/YYYY)
8/26/2015
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3. Issuer Name
and
Ticker or Trading Symbol
AxoGen, Inc. [AXGN]
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(Last)
(First)
(Middle)
21 WATERWAY AVENUE, SUITE 225
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
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X
___ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
THE WOODLANDS, TX 77380
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
___ Form filed by One Reporting Person
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X
_ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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4861111
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D
(1)
(2)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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The shares are held by Essex Woodlands Fund IX, L.P. ("Fund IX"). Essex Woodlands Fund IX-GP, L.P. (the "Fund IX-GP") is the general partner of Fund IX. Essex Woodlands IX, LLC (the "General Partner") is the general partner of the Fund IX-GP. The General Partner holds sole voting and dispositive power over the shares held by Fund IX. The managers of the General Partner are Martin P. Sutter, R. Scott Barry, Ronald Eastman, Guido J. Neels (also a member of the Issuer's board of directors), Petri Vainio and Steve Wiggins (collectively, the "Managers"), and may exercise voting and investment control over the shares only by the majority action of the Managers.
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(
2)
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Each individual Manager, the Fund-IX-GP and the General Partner disclaims beneficial ownership over the shares except to the extent of his or its respective pecuniary interest therein.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Essex Woodlands Fund IX, L.P.
21 WATERWAY AVENUE, SUITE 225
THE WOODLANDS, TX 77380
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X
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Essex Woodlands Fund IX-GP, L.P.
21 WATERWAY AVENUE, SUITE 225
THE WOODLANDS, TX
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X
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Essex Woodlands IX, LLC
21 WATERWAY AVENUE, SUITE 225
THE WOODLANDS, TX 77380
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X
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Signatures
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Essex Woodlands Fund IX, L.P.; By Essex Woodlands Fund IX-GP, L.P. its General Partner; By Essex Woodlands IX, LLC, its General Partner; By /s/ Martin P. Sutter, Managing Director
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9/2/2015
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**
Signature of Reporting Person
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Date
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Essex Woodlands IX-GP, L.P.; By: Essex Woodlands IX, LLC; By: /s/ Martin P. Sutter, Managing Director
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9/2/2015
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**
Signature of Reporting Person
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Date
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Essex Woodlands IX, LLC, By: /s/ Martin P. Sutter, Managing Director
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9/2/2015
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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