0000899243-19-023889.txt : 20190918
0000899243-19-023889.hdr.sgml : 20190918
20190918214413
ACCESSION NUMBER: 0000899243-19-023889
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190918
FILED AS OF DATE: 20190918
DATE AS OF CHANGE: 20190918
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: H.I.G. Bio-Exagen, L.P.
CENTRAL INDEX KEY: 0001788396
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39049
FILM NUMBER: 191100905
BUSINESS ADDRESS:
STREET 1: C/O EXAGEN INC.
STREET 2: 1261 LIBERTY WAY, SUITE C
CITY: VISTA
STATE: CA
ZIP: 92081
BUSINESS PHONE: (760) 560-1501
MAIL ADDRESS:
STREET 1: C/O EXAGEN INC.
STREET 2: 1261 LIBERTY WAY, SUITE C
CITY: VISTA
STATE: CA
ZIP: 92081
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: H.I.G.-GPII, Inc.
CENTRAL INDEX KEY: 0001788482
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39049
FILM NUMBER: 191100906
BUSINESS ADDRESS:
STREET 1: C/O EXAGEN INC.
STREET 2: 1261 LIBERTY WAY, SUITE C
CITY: VISTA
STATE: CA
ZIP: 92081
BUSINESS PHONE: (760) 560-1501
MAIL ADDRESS:
STREET 1: C/O EXAGEN INC.
STREET 2: 1261 LIBERTY WAY, SUITE C
CITY: VISTA
STATE: CA
ZIP: 92081
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: TAMER ANTHONY
CENTRAL INDEX KEY: 0001050045
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39049
FILM NUMBER: 191100907
MAIL ADDRESS:
STREET 1: 1001 SOUTH BAYSHORE DRIVE
STREET 2: STE 2708
CITY: MIAMI
STATE: FL
ZIP: 33131
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MNAYMNEH SAMI
CENTRAL INDEX KEY: 0001050046
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39049
FILM NUMBER: 191100908
MAIL ADDRESS:
STREET 1: 1001 SOUTH BAYSHORE DRIVE
STREET 2: STE 2708
CITY: MIAMI
STATE: FL
ZIP: 33131
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: EXAGEN INC.
CENTRAL INDEX KEY: 0001274737
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
BUSINESS ADDRESS:
STREET 1: 1261 LIBERTY WAY
CITY: VISTA
STATE: CA
ZIP: 92081
BUSINESS PHONE: (760) 560-1501
MAIL ADDRESS:
STREET 1: 1261 LIBERTY WAY
CITY: VISTA
STATE: CA
ZIP: 92081
FORMER COMPANY:
FORMER CONFORMED NAME: EXAGEN DIAGNOSTICS INC
DATE OF NAME CHANGE: 20031230
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2019-09-18
0
0001274737
EXAGEN INC.
XGN
0001788396
H.I.G. Bio-Exagen, L.P.
1450 BRICKELL AVENUE, 31ST FLOOR
MIAMI
FL
33131
0
0
1
0
0001788482
H.I.G.-GPII, Inc.
1450 BRICKELL AVENUE, 31ST FLOOR
MIAMI
FL
33131
0
0
1
0
0001050045
TAMER ANTHONY
1450 BRICKELL AVENUE, 31ST FLOOR
MIAMI
FL
33131
0
0
1
0
0001050046
MNAYMNEH SAMI
1450 BRICKELL AVENUE, 31ST FLOOR
MIAMI
FL
33131
0
0
1
0
Series H Redeemable Convertible Preferred Stock
Common Stock
1271252
I
See footnote
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 will automatically convert into Common Stock upon the closing of the Issuer's initial public offering.
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.
H.I.G. Bio-Exagen, L.P., By: H.I.G.-GPII, Inc., its general partner, By: /s/ Richard Siegel, Name: Richard Siegel, Title: Authorized Signatory
2019-09-18
H.I.G.-GPII, Inc., By: /s/ Richard Siegel, Name: Richard Siegel, Title: Authorized Signatory
2019-09-18
/s/ Anthony Tamer
2019-09-18
/s/ Sami Mnaymneh
2019-09-18