0001179110-21-007131.txt : 20210629
0001179110-21-007131.hdr.sgml : 20210629
20210629180118
ACCESSION NUMBER: 0001179110-21-007131
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210628
FILED AS OF DATE: 20210629
DATE AS OF CHANGE: 20210629
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BUCKMAN PAUL
CENTRAL INDEX KEY: 0001215243
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40518
FILM NUMBER: 211059462
MAIL ADDRESS:
STREET 1: 12988 VALLEY VIEW RD
CITY: EDEN PRAIRIE
STATE: MN
ZIP: 55402
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Miromatrix Medical Inc.
CENTRAL INDEX KEY: 0001527096
STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836]
IRS NUMBER: 271285782
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 10399 WEST 70TH STREET
CITY: EDEN PRAIRIE
STATE: MN
ZIP: 55344
BUSINESS PHONE: (612)202-7026
MAIL ADDRESS:
STREET 1: 10399 WEST 70TH STREET
CITY: EDEN PRAIRIE
STATE: MN
ZIP: 55344
4
1
edgar.xml
FORM 4 -
X0306
4
2021-06-28
0
0001527096
Miromatrix Medical Inc.
MIRO
0001215243
BUCKMAN PAUL
1039 WEST 70TH STREET
EDEN PRAIRIE
MN
55344
1
0
0
0
Common Stock
2021-06-28
4
C
0
3000
A
8555
I
By Paul R. Buckman Revocable Trust
Series B-2 Preferred Stock
2021-06-28
4
C
0
3000
D
2021-05-21
Common Stock
3000
0
I
By Paul R. Buckman Revocable Trust
Each share of Series B-2 Preferred Stock had no expiration date and automatically converted into one share of Common Stock upon the closing of the Issuer's initial public offering.
/s/ Elise B. Houser, Attorney-in-Fact
2021-06-29