Amended Statement of Ownership (sc 13g/a)
February 13 2023 - 5:08PM
Edgar (US Regulatory)
Securities and Exchange Commission
Washington, D.C. 20549
Schedule 13G
(Rule 13d-102)
Information to be Included in Statements Filed Pursuant
to § 240.13d-1(b), (c) and (d) and Amendments Thereto Filed
Pursuant to § 240.13d-2
UNDER THE SECURITIES EXCHANGE ACT OF 1934
(Amendment No. 1)*
Paragon 28,
Inc.
(Name of Issuer)
Common Stock
(Title of
Class of Securities)
69913P105
(CUSIP Number)
December 31, 2022
(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to
designate the rule pursuant to which this Schedule is filed:
* |
The remainder of this cover page shall be filled out for a reporting persons initial filing on this form
with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page. |
The information required in the remainder of this cover page shall not be deemed to be filed for the purpose of Section 18 of the Securities
Exchange Act of 1934 (Act) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
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CUSIP No. 69913P105 |
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Schedule 13G |
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Page 1 of 5 |
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1 |
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Names of Reporting Persons
Albert DaCosta |
2 |
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Check the Appropriate Box
if a Member of a Group
(a) ☐ (b) ☐ |
3 |
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SEC Use Only
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4 |
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Citizenship or Place of
Organization United
States |
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Number of
Shares Beneficially
Owned by Each
Reporting Person
With |
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5 |
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Sole Voting Power
1,227,314 |
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6 |
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Shared Voting Power
11,555,610 |
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7 |
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Sole Dispositive Power
1,227,314 |
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8 |
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Shared Dispositive Power
11,555,610 |
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9 |
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Aggregate Amount Beneficially Owned by Each Reporting Person
12,782,924 |
10 |
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Check if the Aggregate
Amount in Row (9) Excludes Certain Shares Not
Applicable |
11 |
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Percent of Class
Represented by Amount in Row 9 16.6% |
12 |
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Type of Reporting
Person IN |
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CUSIP No. 69913P105 |
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Schedule 13G |
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Page 2 of 5 |
ITEM 1. |
(a) Name of Issuer: |
Paragon 28, Inc. (the Issuer).
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(b) |
Address of Issuers Principal Executive Offices: |
14445 Grasslands Drive, Englewood, CO 80112
ITEM 2. |
(a) Name of Person Filing: |
This statement is filed on behalf of Albert DaCosta (the Reporting Person).
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(b) |
Address or Principal Business Office: |
The business address of the Reporting Person is c/o Paragon 28, Inc., 14445 Grasslands Drive, Englewood, CO 80112.
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(c) |
Citizenship of each Reporting Person is: |
Albert DaCosta is a citizen of the United States.
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(d) |
Title of Class of Securities: |
Common Stock, par value $0.01 per share (Common Stock).
69913P105
Not applicable.
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CUSIP No. 69913P105 |
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Schedule 13G |
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Page 3 of 5 |
(a-c)
The ownership information presented below represents beneficial ownership of Common Stock of the Issuer as of December 31,
2022, based upon 77,126,895 shares of Common Stock outstanding as of November 7, 2022, as disclosed in the Issuers Quarterly Report on Form 10-Q filed with the Securities and Exchange Commission on
November 10, 2022.
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Reporting Person |
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Amount
beneficially
owned |
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Percent
of class: |
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Sole power to vote or to direct the vote: |
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Shared power to vote or to direct the vote: |
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Sole power to dispose or to direct the disposition
of: |
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Shared
power to dispose or
to direct the
disposition
of: |
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Albert DaCosta |
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12,782,924 |
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16.6 |
% |
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1,227,314 |
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12,782,924 |
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1,227,314 |
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12,782,924 |
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Albert DaCosta may be deemed the beneficial owner of 12,782,924 shares of Common Stock, which
includes (i) 172,890 shares of Common Stock held directly by Mr. DaCosta, (ii) 341,665 shares of Common Stock held in an IRA for the benefit of Mr. DaCosta, (iii) 5,000,000 shares of Common Stock held by DaCosta Investment Company, LLC, of
which Mr. DaCosta is a manager, (iv) 6,480,610 shares of Common Stock held by The DaCosta Family Trust, of which Mr. DaCosta is trustee, (v) 75,000 shares of Common Stock held in an IRA for the benefit of Mr. DaCostas spouse and (vi)
712,759 shares of Common Stock underlying stock options that vest on or prior to March 1, 2023.
ITEM 5. |
Ownership of Five Percent or Less of a Class. |
Not applicable.
ITEM 6. |
Ownership of More than Five Percent on Behalf of Another Person. |
Not applicable.
ITEM 7. |
Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the
Parent Holding Company. |
Not applicable.
ITEM 8. |
Identification and Classification of Members of the Group. |
Not applicable.
ITEM 9. |
Notice of Dissolution of Group. |
Not applicable.
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CUSIP No. 69913P105 |
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Schedule 13G |
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Page 4 of 5 |
Not applicable.
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CUSIP No. 69913P105 |
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Schedule 13G |
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Page 5 of 5 |
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true,
complete and correct.
Date: February 13, 2023
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Albert DaCosta |
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/s/ Albert DaCosta |
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