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 |
|
| ||||||||||||||||||||||||||||||
|
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) |
||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series A Convertible Preferred Stock | Â (5) | Â (5) | Common Stock | 736,583 | $ (5) | D (1) | Â |
Series A Convertible Preferred Stock | Â (5) | Â (5) | Common Stock | 14,877 | $ (5) | D (2) | Â |
Series A Convertible Preferred Stock | Â (5) | Â (5) | Common Stock | 24,871 | $ (5) | D (3) | Â |
Series A Convertible Preferred Stock | Â (5) | Â (5) | Common Stock | 29,634 | $ (5) | D (4) | Â |
Series A Convertible Preferred Stock | Â (5) | Â (5) | Common Stock | 681,715 | $ (5) | D (6) | Â |
Common Stock Warrant (Right to Buy) | 01/22/2009 | 01/21/2014 | Common Stock | 17,973 | $ 2.69 | D (1) | Â |
Common Stock Warrant (Right to Buy) | 01/22/2009 | 01/21/2014 | Common Stock | 629 | $ 2.69 | D (3) | Â |
Common Stock Warrant (Right to Buy) | 01/22/2009 | 01/21/2014 | Common Stock | 749 | $ 2.69 | D (4) | Â |
Common Stock Warrant (Right to Buy) | 01/22/2009 | 01/21/2014 | Common Stock | 17,839 | $ 2.69 | D (6) | Â |
Common Stock Warrant (Right to Buy) | 12/29/2010 | 12/29/2017 | Common Stock | 20,220 | $ 13.44 | D (1) | Â |
Common Stock Warrant (Right to Buy) | 12/29/2010 | 12/29/2017 | Common Stock | 708 | $ 13.44 | D (3) | Â |
Common Stock Warrant (Right to Buy) | 12/29/2010 | 12/29/2017 | Common Stock | 843 | $ 13.44 | D (4) | Â |
Common Stock Warrant (Right to Buy) | 12/29/2010 | 12/29/2017 | Common Stock | 20,069 | $ 13.44 | D (6) | Â |
Convertible Promissory Notes | Â (7) | Â (7) | Common Stock | 344,355 | $ (7) | D (1) | Â |
Convertible Promissory Notes | Â (7) | Â (7) | Common Stock | 12,058 | $ (7) | D (3) | Â |
Convertible Promissory Notes | Â (7) | Â (7) | Common Stock | 14,366 | $ (7) | D (4) | Â |
Convertible Promissory Notes | Â (7) | Â (7) | Common Stock | 341,788 | $ (7) | D (6) | Â |
Convertible Promissory Notes | Â (8) | Â (8) | Common Stock | 129,445 | $ (8) | D (1) | Â |
Convertible Promissory Notes | Â (8) | Â (8) | Common Stock | 5,400 | $ (8) | D (3) | Â |
Convertible Promissory Notes | Â (8) | Â (8) | Common Stock | 128,479 | $ (8) | D (6) | Â |
Convertible Promissory Notes | Â (8) | Â (8) | Common Stock | 4,533 | $ (8) | D (4) | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Sanderling Venture Partners VI LP C/O SANDERLING VENTURES 400 SOUTH EL CAMINO REAL, SUITE 1200 SAN MATEO, CA 94402 |
 |  X |  |  |
Sanderling Ventures Management VI C/O SANDERLING VENTURES 400 SOUTH EL CAMINO REAL, SUITE 1200 SAN MATEO, CA 94402 |
 |  X |  |  |
Sanderling VI Beteiligungs GmbH & Co KG C/O SANDERLING VENTURES 400 SOUTH EL CAMINO REAL, SUITE 1200 SAN MATEO, CA 94402 |
 |  X |  |  |
Sanderling VI Limited Partnership C/O SANDERLING VENTURES 400 SOUTH EL CAMINO REAL, SUITE 1200 SAN MATEO, CA 94402 |
 |  X |  |  |
Sanderling Venture Partners VI Co Investment Fund LP C/O SANDERLING VENTURES 400 SOUTH EL CAMINO REAL, SUITE 1200 SAN MATEO, CA 94402 |
 |  X |  |  |
See Ex . 99.1 | 02/02/2011 | |
**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) | The securities are held by Sanderling Venture Partners VI, L.P. |
(2) | The securities are held by Sanderling Ventures Management VI. |
(3) | The securities are held by Sanderling VI Beteiligungs GmbH & Co. KG. |
(4) | The securities are held by Sanderling VI Limited Partnership. |
(5) | The Series A Convertible Preferred Stock has no expiration date and each share of Series A Convertible Preferred Stock will automatically convert into one share of Common Stock upon the consummation of the Issuer's initial public offering. |
(6) | The securities are held by Sanderling Venture Partners VI Co-Investment Fund. |
(7) | All principal and accrued interest on the Convertible Promissory Notes will automatically convert into shares of Common Stock upon the consummation of the Issuer's initial public offering. |
(8) | All principal on the Convertible Promissory Notes will automatically convert into shares of Common Stock upon the consummation of the Issuer's initial public offering at a conversion price equal to the per share price of the Common Stock sold in the Issuer's initial public offering. |