Cheshire MD Holdings, LLC - 28 Jun 2021 Form 4 Insider Report for Miromatrix Medical Inc.

Role
10%+ Owner
Signature
By: Cheshire MD Holdings, LLC Name: Steve Phillips Title: Vice President /s/ Stephanie Berberich, Attorney-in-Fact
Issuer symbol
N/A
Transactions as of
28 Jun 2021
Net transactions value
$0
Form type
4
Filing time
29 Jun 2021, 18:08:24 UTC
Previous filing
23 Jun 2021
SEC
View on sec.gov

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
transaction MIRO Common Stock Conversion of derivative security +933,334 933,334 28 Jun 2021 Direct F1, F2
transaction MIRO Common Stock Conversion of derivative security +1,046,757 +112% 1,980,091 28 Jun 2021 Direct F2, F3

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
transaction MIRO Series B-2 Preferred Stock Conversion of derivative security $0 -933,334 -100% $0.000000* 0 28 Jun 2021 Common Stock 933,334 Direct F1, F2
transaction MIRO Series C Preferred Stock Conversion of derivative security $0 -1,004,887 -100% $0.000000* 0 28 Jun 2021 Common Stock 1,046,757 Direct F2, F3
* 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 had no expiration date and automatically converted into one share 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 Each share of Series C Preferred Stock had no expiration date and automatically converted into shares of Common Stock upon the closing of the Issuer's IPO at a rate determined by dividing $7.50 by $7.20.