0000899243-21-017461.txt : 20210429 0000899243-21-017461.hdr.sgml : 20210429 20210429210919 ACCESSION NUMBER: 0000899243-21-017461 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210427 FILED AS OF DATE: 20210429 DATE AS OF CHANGE: 20210429 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TREACE JAMES T CENTRAL INDEX KEY: 0001185191 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40355 FILM NUMBER: 21873294 MAIL ADDRESS: STREET 1: 117 BRISTOL PLACE CITY: PONTE VEDRA BEACH STATE: FL ZIP: 32082 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: TREACE MEDICAL CONCEPTS, INC. CENTRAL INDEX KEY: 0001630627 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 471052611 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 203 FORT WADE ROAD STREET 2: SUITE 150 CITY: PONTE VEDRA STATE: FL ZIP: 32081 BUSINESS PHONE: (904) 373-5940 MAIL ADDRESS: STREET 1: 203 FORT WADE ROAD STREET 2: SUITE 150 CITY: PONTE VEDRA STATE: FL ZIP: 32081 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-04-27 0 0001630627 TREACE MEDICAL CONCEPTS, INC. TMCI 0001185191 TREACE JAMES T C/O TREACE MEDICAL CONCEPTS, INC. 203 FORT WADE RD., SUITE 150 PONTE VEDRA FL 32081 1 0 0 0 Common Stock 2021-04-27 4 C 0 399633 A 2205258 D Common Stock 2021-04-27 4 C 0 569067 A 1478946 I J&A Group, LLC Series A Preferred Stock 2021-04-27 4 J 0 9250 0.00 A Common Stock 9250 399633 D Series A Preferred Stock 2021-04-27 4 J 0 13169 0.00 A Common Stock 13169 569067 I J&A Group, LLC Series A Preferred Stock 2021-04-27 4 C 0 399632 0.00 D Common Stock 399633 0 D Series A Preferred Stock 2021-04-27 4 C 0 569067 0.00 D Common Stock 569067 0 I J&A Group, LLC Each share of the Issuer's Series A Preferred Stock automatically converted into one (1) share of the Issuer's Common Stock immediately upon the closing of the Issuer's initial public offering. The shares had no expiration date. James T. Treace and his spouse are managing members of J&A Group, LLC, a Florida limited liability company. The Reporting Person received Series A Preferred Stock as a payment-in-kind dividend. /s/ Jaime A. Frias as Attorney-in-fact for James T. Treace 2021-04-29