| FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 12/13/2016 | 3. Issuer Name and Ticker or Trading Symbol RTI SURGICAL, INC. [ RTIX ] | |||||||||||||
| 4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Beneficially Owned | |||
|---|---|---|---|
| 1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
| Common Stock | 30,585(1) | D | |
| Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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| 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: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
| Option to purchase Common Stock, $.001 par value per share | (2) | 07/16/2022 | Common Stock, par value $.001 | 60,000 | 3.5 | D | |
| Option to purchase Common Stock, $.001 par value per share | (3) | 02/25/2023 | Common Stock, par value $.001 | 40,000 | 3.6 | D | |
| Option to purchase Common Stock, $.001 par value per share | (4) | 02/25/2024 | Common Stock, par value $.001 | 20,000 | 3.78 | D | |
| Option to purchase Common Stock, $.001 par value per share | (5) | 02/17/2025 | Common Stock, par value $.001 | 20,000 | 5.23 | D | |
| Option to purchase Common Stock, $.001 par value per share | (6) | 02/24/2026 | Common Stock, par value $.001 | 38,710 | 3.31 | D | |
| Explanation of Responses: |
| 1. This contains 12,085 Restricted Stock Awards that will vest as to 4,029 on 2/24/2017 and 4,028 on each of 2/24/2018 and 2/24/2019. |
| 2. Consist of 48,000 fully vested and exercisable options and 12,000 unvested options that will vest and become exercisable on 7/16/2017. |
| 3. Consist of 24,000 fully vested and exercisable options and 16,000 unvested options that will vest and become exercisable as to 8,000 on each of 2/25/2017 and 2/25/2018. |
| 4. Consist of 8,000 fully vested and exercisable options and 12,000 unvested options that will vest and become exercisable as to 4,000 shares on each of 2/25/2017, 2/25/2018 and 2/25/2019. |
| 5. Consist of 4,000 fully vested and exercisable options and 16,000 unvested options that will vest and become exercisable as to 4,000 shares on each of 2/17/2017, 2/17/2018, 2/17/2019 and 2/17/2020. |
| 6. This option will become exercisable as to 7,742 shares on each of 2/24/2017, 2/24/2018, 2/24/2019, 2/24/2020 and 2/24/2021. |
| /s/Kevin D. Brandt | 12/20/2016 | |
| ** Signature of Reporting Person | Date | |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
| * 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). | ||
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
| 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 Number. | ||
