0001104659-20-134246.txt : 20201210 0001104659-20-134246.hdr.sgml : 20201210 20201210165027 ACCESSION NUMBER: 0001104659-20-134246 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201209 FILED AS OF DATE: 20201210 DATE AS OF CHANGE: 20201210 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jordan Maybelle CENTRAL INDEX KEY: 0001826123 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39577 FILM NUMBER: 201381180 MAIL ADDRESS: STREET 1: C/O AZIYO BIOLOGICS, INC. STREET 2: 12510 PROSPERITY DRIVE, SUITE 370 CITY: SILVER SPRING STATE: MD ZIP: 20904 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AZIYO BIOLOGICS, INC. CENTRAL INDEX KEY: 0001708527 STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836] IRS NUMBER: 474790334 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 12510 PROSPERITY DRIVE STREET 2: SUITE 370 CITY: SILVER SPRING STATE: MD ZIP: 20904 BUSINESS PHONE: 240-247-1143 MAIL ADDRESS: STREET 1: 12510 PROSPERITY DRIVE STREET 2: SUITE 370 CITY: SILVER SPRING STATE: MD ZIP: 20904 4 1 tm2038235-3_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2020-12-09 0 0001708527 AZIYO BIOLOGICS, INC. AYZO 0001826123 Jordan Maybelle C/O AZIYO BIOLOGICS, INC. 12510 PROSPERITY DRIVE, SUITE 370 SILVER SPRING MD 20904 1 0 0 0 STOCK OPTION (RIGHT TO BUY) 17.00 2020-12-09 4 A 0 14307 0.00 A 2030-12-08 CLASS A COMMON STOCK 14307 14307 D This option vests and becomes exercisable in three equal installments on each of October 8, 2021, 2022 and 2023. /s/ Jeffrey Hamet, Attorney-in-Fact for Maybelle Jordan 2020-12-10