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-1 Convertible Participating Preferred Stock
|
Â
(2)
|
Â
(3)
|
Common Stock
|
72,069
(2)
(4)
|
$
(2)
|
I
|
By Skyline Venture Partners Qualified Purchaser IV L.P.
(4)
|
Series A-2 Convertible Participating Preferred Stock
|
Â
(2)
|
Â
(3)
|
Common Stock
|
94,003
(2)
(4)
|
$
(2)
|
I
|
By Skyline Venture Partners Qualified Purchaser IV L.P.
(4)
|
Series B Convertible Participating Preferred Stock
|
Â
(2)
|
Â
(3)
|
Common Stock
|
393,864
(2)
(4)
|
$
(2)
|
I
|
By Skyline Venture Partners Qualified Purchaser IV L.P.
(4)
|
Series C Convertible Participating Preferred Stock
|
Â
(2)
|
Â
(3)
|
Common Stock
|
938,853
(2)
(4)
|
$
(2)
|
I
|
By Skyline Venture Partners Qualified Purchaser IV L.P
(4)
|
* |
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) |
Reflects a one-for-twenty-nine reverse stock split effected March 5, 2013. |
(2) |
Convertible into Common stock on a 1-for-29 basis without payment of further consideration. Each share will automatically convert into 1/29th of a share of Common Stock upon the closing of the Issuer's initial public offering. |
(3) |
Not Applicable |
(4) |
Held by Skyline Venture Partners Qualified Purchaser IV L.P. Skyline Venture Management IV, LLC is the General Partner of Skyline Venture Partners Qualified Purchaser IV L.P. John Freund is a Managing Director of Skyline Venture Management IV, LLC. Mr. Freund may be deemed to share voting and dispositive power with respect to all shares held by Skyline Venture Partners Qualified Purchaser IV L.P. Mr. Freund disclaims beneficial ownership of the shares except to the extent of any pecuniary interest therein. |