Cheshire MD Holdings, LLC - Jun 23, 2021 Form 3 Insider Report for Miromatrix Medical Inc. (MIRO)

Role: 10%+ Owner
Signature: By: Cheshire MD Holdings, LLC Name: Steve Phillips Title: Vice President /s/ Steve Phillips
Stock symbol: MIRO
Transactions as of: Jun 23, 2021
Transactions value $: $0
Form type: 3
Date filed: 6/23/2021, 09:46 PM
Next filing: Jun 29, 2021

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type	Sym	Class	Transaction	Value $	Shares	Change %	* Price $	Shares After	Date	Underlying Class	Amount	Exercise Price	Ownership	Footnotes
holding	MIRO	Series B-2 Preferred Stock							Jun 23, 2021	Common Stock	933K		Direct	F1, F2
holding	MIRO	Warrants							Jun 23, 2021	Series C Preferred Stock	240K		Direct	F2, F3
holding	MIRO	Convertible Promissory Note							Jun 23, 2021	Series C Preferred Stock	957K		Direct	F2, F4

* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id	Content
F1	Each share of Series B-2 Preferred Stock will automatically convert into shares of Common Stock upon the closing of the Issuer's Initial Public Offering ("IPO").
F2	As a result of DaVita Inc.'s ownership interest in Cheshire MD Holdings, LLC, DaVita Inc. may be deemed to have an indirect pecuniary interest in the shares held directly by Cheshire MD Holdings, LLC.
F3	The Warrants will be exercised for 240,000 shares of Series C Preferred Stock immediately prior to the underwriting agreement being signed in connection with Issuer's IPO.
F4	The Convertible Promissory Note will convert into 956,887 shares of Series C Preferred Stock immediately prior to the underwriting agreement being signed in connection with the Issuer's IPO.