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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series A Preferred Stock | (1) | 02/04/2014 | C | 312,000 | (1) | (1) | Common Stock | 312,000 | $ 0 | 0 | I | See Footnote (2) | |||
Series B Preferred Stock | (1) | 02/04/2014 | C | 179,322 | (1) | (1) | Common Stock | 179,322 | $ 0 | 0 | I | See Footnote (2) | |||
Series C Preferred Stock | (1) | 02/04/2014 | C | 1,043,429 | (1) | (1) | Common Stock | 1,043,429 | $ 0 | 0 | I | See Footnote (2) | |||
Common Stock Warrant | $ 250 | 02/04/2014 | C | 755 | (3) | (3) | Common Stock | 755 | $ 0 | 755 | I | See Footnote (2) | |||
Series C Preferred Stock Warrants | $ 7 | 02/04/2014 | C | 21,697 | (4) | (4) | Common Stock | 21,697 | $ 0 | 0 | I | See Footnote (2) | |||
Common Stock Warrant (right to buy) | $ 7 | 02/04/2014 | C | 21,697 | (4) | (4) | Common Stock | 21,697 | $ 0 | 21,697 | I | See Footnote (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HOFFMAN STEPHEN J 525 UNIVERSITY AVENUE PALO ALTO, CA 94301 |
X | X |
Stephen Hoffman, M.D., Ph.D. /s/ Kerensa Kenny, Attorney-in-Fact | 02/05/2014 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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) | Each share of Series A Preferred Stock, Series B Preferred Stock and Series C Preferred Stock is convertible into one share of the Issuer's Common Stock and will automatically convert into one share of the Issuer's Common Stock upon the closing of the Issuer's initial public offering without payment of further consideration. The shares have no expiration date. |
(2) | These securities are held by Skyline Ventures Partners V, L.P. ("Skyline V"). Skyline Venture Management V, LLC serves as the sole general partner of Skyline V. The reporting person is a non-managing member of Skyline Venture Management V, LLC. The reporting person disclaims beneficial ownership of the shares reported herein, except to the extent of his pecuniary interest therein. |
(3) | Warrants will expire June 17, 2020. |
(4) | Warrants will expire June 17, 2020. |