0001209191-23-002660.txt : 20230109 0001209191-23-002660.hdr.sgml : 20230109 20230109190813 ACCESSION NUMBER: 0001209191-23-002660 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20230105 FILED AS OF DATE: 20230109 DATE AS OF CHANGE: 20230109 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Serbousek Jon Carl CENTRAL INDEX KEY: 0001536875 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19961 FILM NUMBER: 23519379 MAIL ADDRESS: STREET 1: C/O BIOMET, INC. STREET 2: P.O. BOX 587 CITY: WARSAW STATE: IN ZIP: 46581-0587 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Orthofix Medical Inc. CENTRAL INDEX KEY: 0000884624 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 000000000 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3451 PLANO PARKWAY CITY: LEWISVILLE STATE: TX ZIP: 75056 BUSINESS PHONE: 214-937-2000 MAIL ADDRESS: STREET 1: 3451 PLANO PARKWAY CITY: LEWISVILLE STATE: TX ZIP: 75056 FORMER COMPANY: FORMER CONFORMED NAME: ORTHOFIX INTERNATIONAL N V DATE OF NAME CHANGE: 19970708 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2023-01-05 0 0000884624 Orthofix Medical Inc. OFIX 0001536875 Serbousek Jon Carl 3451 PLANO PARKWAY LEWISVILLE TX 75056 1 1 0 0 Executive Chairman Common Stock 2023-01-05 4 A 0 45872 0.00 A 235379 D Common Stock 2023-01-05 4 A 0 40764 0.00 A 276143 D Common Stock 2023-01-05 4 A 0 81967 0.00 A 358110 D Represents outstanding performance stock units for awards granted in 2020, which as a result of the Orthofix Board's determination to treat the merger with SeaSpine Holdings Corporation as a change in control (referred to as a "corporate transaction" under Orthofix's Amended and Restated 2012 Long-Term Incentive Plan) were deemed achieved at target levels as of the merger date and converted to time-based awards that vest on June 8, 2023. Represents outstanding performance stock units for awards granted in 2021, which as a result of the Orthofix Board's determination to treat the merger with SeaSpine Holdings Corporation as a change in control (referred to as a "corporate transaction" under Orthofix's Amended and Restated 2012 Long-Term Incentive Plan) were deemed achieved at target levels as of the merger date and converted to time-based awards that vest on April 1, 2024. Represents outstanding performance stock units for awards granted in 2022, which as a result of the Orthofix Board's determination to treat the merger with SeaSpine Holdings Corporation as a change in control (referred to as a "corporate transaction" under Orthofix's Amended and Restated 2012 Long-Term Incentive Plan) were deemed achieved at target levels as of the merger date and converted to time-based awards that vest on January 31, 2025. Includes 307,621 unvested restricted stock units. /s/ Patrick Keran, attorney-in-fact 2023-01-09 EX-24 2 poa.txt POA DOCUMENT Power of Attorney Know all by these presents, that the undersigned hereby makes, constitutes and appoints each of Patrick L. Keran and John Bostjancic, or either of them acting singly, and with full power of substitution and re-substitution, the undersigned's true and lawful attorney-in-fact (each of such persons and their substitutes being referred to herein as the "Attorney-in-Fact"), with full power to act for the undersigned and in the undersigned's name, place and stead, in any and all capacities, to: 1. Prepare, execute and submit to the SEC, Orthofix Medical Inc. (the "Company"), and/or any national securities exchange on which the Company's securities are listed any and all reports (including any amendments thereto) the undersigned is required to file with the SEC, or which the Attorney-in-Fact considers it advisable to file with the SEC, under Section 13 or Section 16 of the Exchange Act or any rule or regulation thereunder, or under Rule 144 under the Securities Act of 1933 ("Rule 144"), with respect to the any security of the Company, including Forms 3, 4 and 5, Schedules 13D and 13G, and Forms 144; and 2. Obtain, as the undersigned's representative and on the undersigned's behalf, information regarding transactions in the Company's equity securities from any third party, including the Company and any brokers, dealers, employee benefit plan administrators and trustees, and the undersigned hereby authorizes any such third party to release any such information to the Attorney-in-Fact. The undersigned acknowledges that: a) This Power of Attorney authorizes, but does not require, the Attorney-in-Fact to act in his discretion on information provided to such Attorney-in-Fact without independent verification of such information; b) Any documents prepared or executed by the Attorney-in-Fact on behalf of the undersigned pursuant to this Power of Attorney will be in such form and will contain such information as the Attorney-in-Fact, in his discretion, deems necessary or desirable; c) Neither the Company nor the Attorney-in-Fact assumes any liability for the undersigned's responsibility to comply with the requirements of Section 13 or Section 16 of the Exchange Act or Rule 144, any liability of the undersigned for any failure to comply with such requirements, or any liability of the undersigned for disgorgement of profits under Section 16(b) of the Exchange Act; and d) This Power of Attorney does not relieve the undersigned from responsibility for compliance with the undersigned's obligations under Section 13 or Section 16 of the Exchange Act, including, without limitation, the reporting requirements under Section 13 or Section 16 of the Exchange Act. The undersigned hereby grants to the Attorney-in-Fact full power and authority to do and perform each and every act and thing requisite, necessary or advisable to be done in connection with the foregoing, as fully, to all intents and purposes, as the undersigned might or could do in person, hereby ratifying and confirming all that the Attorney-in-Fact, or his or her substitute or substitutes, shall lawfully do or cause to be done by authority of this Power of Attorney. This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 4 or 5 or Schedules 13D or 13G or Forms 144 with respect to the undersigned's holdings of and transactions in securities of the Company, unless earlier revoked by the undersigned in a signed writing delivered to the Attorney-in-Fact. This Power of Attorney revokes all previous powers of attorney with respect to the subject matter of this Power of Attorney. IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney as of January 5, 2023. /s/ Jon Serbousek Signature