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
(1)
|
Â
(1)
|
Â
(1)
|
Common Stock
|
8,250,300
(1)
|
$
0
|
I
(4)
|
By Partnership
|
Series C Convertible Preferred
(2)
|
Â
(2)
|
Â
(2)
|
Common Stock
|
7,280,001
(2)
|
$
0
|
I
(4)
|
By Partnership
|
Series D Convertible Preferred
(5)
|
Â
(3)
|
Â
(3)
|
Common Stock
|
3,447,188
(3)
|
$
0
|
I
(5)
|
By Partnership
|
* |
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) |
These shares will automatically convert into 1,682,361 shares of Common Stock of the Issuer on the date of the closing of the initial public offering of the Issuer's Common Stock. |
(2) |
These shares will automatically convert into 1,484,502 shares of Common Stock of the Issuer on the date of the closing of the initial public offering of the Issuer's Common Stock. |
(3) |
These shares will automatically convert into 702,933 shares of Common Stock of the Issuer on the date of the closing of the initial public offering of the Issuer's Common Stock. |
(4) |
These securities are owned by HealthCare Ventures VI, L.P. ("HCVVI"). Mr. Lawlor is a general partner of HealthCare Ventures VI, L.P., the General Partner of HCVVI and may be deemed to indirectly beneficially own those securities owned by HCVVI. Mr. Lawlor disclaims beneficial ownership of those securities in which he does not have a pecuniary interest and this report shall not be deemed an admission that he is the beneficial owner of these securities for purposes of Section 16, except to the extent of his pecuniary interest therein. |
(5) |
These securities are owned by HealthCare Ventures VIII, L.P. ("HCVVIII"). Mr. Lawlor is a managing director of HealthCare Partners VIII LLC, which is the general partner of HealthCare Partners VIII, L.P., which is the general parthner of HCVVIII and may be deemed to indirectly benefically own those securities owned by HVVVIII. Mr. Lawlor disclaims beneficial ownership of those securities in which he does not have a pecuniary interest and this report shall not be deemed an admission that he is the beneficial owner of these securities for purposes of Section 16, except to the extent of his pecuniary interest. |