UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series B Redeemable Convertible Preferred Stock | Â (1) | Â (1) | Common Stock | 18,920 | $ (1) | D | Â |
Stock Option (Right to Buy) | Â (2) | 05/14/2016 | Common Stock | 89,459 | $ 5.73 | D | Â |
Stock Option (Right to Buy) | Â (3) | 02/26/2021 | Common Stock | 82,304 | $ 9.26 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
KOSTUIK JOHN PHILIP MD C/O K2M GROUP HOLDINGS, INC. 751 MILLER DRIVE SE LEESBURG, VA 20175 |
 X |  |  Chief Medical Officer |  |
/s/ Luke R. Miller by power of attorney | 05/07/2014 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Upon the closing of the initial public offering of the issuer's common stock, the issuer's Series B Redeemable Convertible Preferred Stock will automatically convert into shares of the issuer's common stock on a one-for-one basis. |
(2) | An option which is fully vested. |
(3) | An option which vests in four equal installments on each anniversary of September 10, 2010. Does not include an additional 82,304 stock options subject to time-based vesting described in the preceding sentence and additional exit-based performance vesting criteria. |
 Remarks: Exhibit List: Exhibit 24 - Power of Attorney. |