Form 3 Olson Eric K.

3 - Initial statement of beneficial ownership of securities

Published: 2014-02-12 21:07:59
Submitted: 2014-02-12
Period Ending In: 2014-02-12
doc3.html FORM 3 SUBMISSION


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SEC FORM 3

SEC Form 3
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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OMB Number: 3235-0104
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hours per response: 0.5
1. Name and Address of Reporting Person*
Olson Eric K.

(Last) (First) (Middle)
C/O AMEDICA CORPORATION
1885 WEST 2100 SOUTH

(Street)
SALT LAKE CITY UT 84119

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/12/2014
3. Issuer Name and Ticker or Trading Symbol
AMEDICA Corp [ AMDA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President and CEO
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
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 25,218(1) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Explanation of Responses:
1. Includes 25,218 restricted stock units, each of which represents a contingent right to receive one share of Issuer's common stock. The restricted stock units vest on the earlier of a change in control or the date of the expiration of the lock up period imposed on the Reporting Person after completion of the closing of the underwritten initial public offering of shares of the Issuer's Common Stock.
Remarks:
/s/ Jonathan Ursprung 02/12/2014
** 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.
1
doc3.xml FORM 3 SUBMISSION
Schema Version:
X0206
Document Type:
3
Period Of Report:
2014-02-12
No Securities Owned:
0

Issuer

Issuer Cik
0001269026
Issuer Name
AMEDICA Corp
Issuer Trading Symbol
AMDA

Reporting Owner

Reporting Owner Id

Rpt Owner Cik
0001598504
Rpt Owner Name
Olson Eric K.

Reporting Owner Address

Rpt Owner Street1
C/O AMEDICA CORPORATION
Rpt Owner Street2
1885 WEST 2100 SOUTH
Rpt Owner City
SALT LAKE CITY
Rpt Owner State
UT
Rpt Owner Zip Code
84119

Reporting Owner Relationship

Is Director
1
Is Officer
1
Is Ten Percent Owner
0
Is Other
0
Officer Title
President and CEO

Non Derivative Holding

Security Title
Common Stock

Shares Owned Following Transaction

Value
25218
@attributes Id
F1
Direct Or Indirect Ownership
D
Footnotes Footnote
Includes 25,218 restricted stock units, each of which represents a contingent right to receive one share of Issuer's common stock. The restricted stock units vest on the earlier of a change in control or the date of the expiration of the lock up period imposed on the Reporting Person after completion of the closing of the underwritten initial public offering of shares of the Issuer's Common Stock.

Owner Signature

Signature Name
/s/ Jonathan Ursprung
Signature Date
2014-02-12
attachment1.htm EX-24 DOCUMENT


> ENT> EX-24 2 attachment1.htm EX-24 DOCUMENT
                               POWER OF ATTORNEY


      Know all by these presents, that the undersigned hereby constitutes and
appoints Kevin Ontiveros, the Chief Legal Officer, Chief Compliance Officer, and
Corporate Secretary of Amedica Corporation (the "Company"), Amy N. Wood,
Corporate Paralegal for the Company, and Daniel Kajunski, Anthony Hubbard,
Kanasha Herbert, Jonathan Ursprung and Caroline Gammill, each of Mintz, Levin,
Cohn, Ferris, Glovsky and Popeo, P.C., signing singly, with full power of
substitution, the undersigned's true and lawful attorney-in-fact to:

      (1)     execute for and on behalf of the undersigned, forms and
              authentication documents for EDGAR Filing Access;

      (2)     do and perform any and all acts for and on behalf of the
              undersigned which may be necessary or desirable to complete and
              execute any such forms and authentication documents;

      (3)     execute for and on behalf of the undersigned, in the undersigned's
              capacity as an officer, director and/or 10% shareholder of the
              Company, Forms 3, 4 and 5 in accordance with Section 16(a) of the
              Securities Exchange Act of 1934 and the rules thereunder;

      (4)     do and perform any and all acts for and on behalf of the
              undersigned which may be necessary or desirable to complete and
              execute any such Form 3, 4 or 5 and timely file such form with the
              United States Securities and Exchange Commission and any stock
              exchange or similar authority; and

      (5)     take any other action of any type whatsoever in connection with
              the foregoing which, in the opinion of such attorney- in - fact,
              may be of benefit to, in the best interest of, or legally required
              by, the undersigned, it being understood that the documents
              executed by such attorney-in-fact, on behalf of the undersigned
              pursuant to this Power of Attorney, shall be in such form and
              shall contain such terms and conditions as such attorney-in-fact
              may approve in such attorney-in-fact's discretion.

      The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be
done by virtue of this power of attorney and the rights and powers herein
granted.  The undersigned acknowledges that the foregoing attorneys-in-fact, in
serving in such capacity at the request of the undersigned, is not assuming, nor
is the Company assuming, any of the undersigned's responsibilities to comply
with Section 16 of the Securities Exchange Act of 1934.

      This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4 and 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact.

      IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed this 25th day of Nov, 2013.

                                        /s/ Eric Olson
                                        ---------------------------------------
                                        Signature

                                        Eric Olson
                                        ---------------------------------------
                                        Print Name

Additional Files
FileSequenceDescriptionTypeSize
0001209191-14-009985.txt   Complete submission text file   8244
$AMDA

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