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) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Series A Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
21,691
|
$
0
(2)
|
I
|
Held by Wife
(1)
|
Series A Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
143,622
|
$
0
(2)
|
I
|
Held by Partisan Management Group
(4)
|
Series A Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
213,190
|
$
0
(2)
|
I
|
Held by The Weldon Foundation
(3)
|
Series B Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
57,061
|
$
0
(2)
|
I
|
Held by Wife
(1)
|
Series B Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
27,880
|
$
0
(2)
|
I
|
Held by Partisan Management Group
(4)
|
Series B Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
27,880
|
$
0
(2)
|
I
|
Held by The Weldon Foundation
(3)
|
Preferred Stock Warrants (Right to Buy)
|
08/10/2005 |
Â
(5)
|
Series B Convertible Preferred Stock
(2)
|
17,118
|
$
5.43
|
I
|
Held by Wife
(1)
|
Preferred Stock Warrants (Right to Buy)
|
08/10/2005 |
Â
(5)
|
Series B Convertible Preferred Stock
(2)
|
8,363
|
$
5.43
|
I
|
Held by Partisan Management Group
(4)
|
Preferred Stock Warrants (Right to Buy)
|
08/10/2005 |
Â
(5)
|
Series B Convertible Preferred Stock
(2)
|
8,363
|
$
5.43
|
I
|
Held by The Weldon Foundation
(3)
|
* |
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) |
Dr. Weldon disclaims beneficial ownership of the securities held by his wife, except as to his pecuniary interest therein. |
(2) |
The shares of Preferred Stock convert on a 1-for-1 basis into Common Stock upon the closing of the Issuer's initial public offering. |
(3) |
Dr. Weldon is the President of The Weldon Foundation. Dr. Weldon disclaims beneficial ownership of the securities held by this entity, except as to his pecuniary interest therein. |
(4) |
Dr. Weldon is a Managing Director of Partisan Management Group. Dr. Weldon disclaims beneficial ownership of the securities held by this entity, except as to his pecuniary interest therein. |
(5) |
Warrants expire on August 10, 2006 (one year from the date of the Issuer's initial public offering). |