0000899243-21-017486.txt : 20210429 0000899243-21-017486.hdr.sgml : 20210429 20210429212023 ACCESSION NUMBER: 0000899243-21-017486 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 John T. CENTRAL INDEX KEY: 0001856380 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40355 FILM NUMBER: 21873326 MAIL ADDRESS: STREET 1: C/O TREACE MEDICAL CONCEPTS, INC. STREET 2: 203 FORT WADE ROAD, SUITE 150 CITY: PONTE VEDRA STATE: FL ZIP: 32081 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 0001856380 Treace John T. C/O TREACE MEDICAL CONCEPTS, INC. 203 FORT WADE RD., SUITE 150 PONTE VEDRA FL 32081 1 1 1 0 Chief Executive Officer Common Stock 2021-04-27 4 C 0 299510 A 11171385 D Common Stock 2021-04-27 4 S 0 5253805 17.00 D 5917580 D Common Stock 1605000 I By Wife Common Stock 1471250 I By Wife as co-trustee of the JTT Irrevocable Trust dated September 30, 2020 Common Stock 1839063 I As Trustee of the Tracy W. Treace Irrevocable Trust dated September 25, 2020 Series A Preferred Stock 2021-04-27 4 J 0 6932 0.00 A Common Stock 6932 299510 D Series A Preferred Stock 2021-04-27 4 C 0 299510 0.00 D Common Stock 299510 0 D 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. These shares were sold by the Reporting Person as a selling stockholder in conjuction with the Issuer's Form S-1 filing, Registration Number 333-254863. The offering closed on April 27, 2021. The reported sale price reflects the price at which the Reporting Person sold shares to the underwriters. The Reporting Person disclaims beneficial ownership of shares held by his wife directly or in trusts for which his wife serves as trustee or co-trustee. The Reporting Person received Series A Preferred Stock as a payment-in-kind dividend. /s/ Jaime A. Frias as Attorney-in-fact for John T. Treace 2021-04-29