0001104659-21-034460.txt : 20210310 0001104659-21-034460.hdr.sgml : 20210310 20210310161835 ACCESSION NUMBER: 0001104659-21-034460 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210308 FILED AS OF DATE: 20210310 DATE AS OF CHANGE: 20210310 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Riebman Jerome CENTRAL INDEX KEY: 0001825821 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39577 FILM NUMBER: 21729929 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 tm219212-3_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2021-03-08 0 0001708527 AZIYO BIOLOGICS, INC. AYZO 0001825821 Riebman Jerome C/O AZIYO BIOLOGICS, INC., 12510 PROSPERITY DRIVE, SUITE 370 SILVER SPRING, MD 20904 0 1 0 0 CHIEF MEDICAL OFFICER STOCK OPTION (RIGHT TO BUY) 14.53 2021-03-08 4 A 0 18750 0.00 A 2031-03-08 CLASS A COMMON STOCK 18750 18750 D RESTRICTED STOCK UNITS 2021-03-08 4 A 0 3125 0.00 A CLASS A COMMON STOCK 3125 3125 D This option vests as to 25% of the shares on March 8, 2022, and in 12 equal quarterly installments thereafter, such that the option shall be fully vested and exercisable on March 8, 2025. Each restricted stock unit represents a contingent right to receive one share of Issuer Class A common stock. The restricted stock units vest in 4 substantially equal annual installments beginning on March 8, 2022 and have no expiration date. /s/ Ronald Lloyd, Attorney-in-fact for Jerome Riebman 2021-03-10