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 |
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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) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series B Convertible Preferred Stock | Â (1) | Â (1) | Common Stock | 679,115 (2) | $ (1) | I | See footnote (3) |
Series C Convertible Preferred Stock | Â (1) | Â (1) | Common Stock | 2,028,309 (2) | $ (1) | I | See footnote (3) |
Warrant to Purchase Common Stock | Â (4) | 08/02/2017 | Common Stock | 541,206 | $ 2.121 | I | See footnote (3) |
Warrant to Purchase Common Stock | Â (4) | 08/02/2017 | Common Stock | 35,905 | $ 2.121 | I | See footnote (3) |
Warrant to Purchase Common Stock | Â (4) | 08/02/2017 | Common Stock | 291,410 | $ 2.121 | I | See footnote (3) |
Warrant to Purchase Common Stock | Â (4) | 08/02/2017 | Common Stock | 1,516 | $ 2.121 | I | See footnote (3) |
Warrant to Purchase Common Stock | Â (4) | 08/02/2017 | Common Stock | 297,029 | $ 2.121 | I | See footnote (3) |
Warrant to Purchase Series C Convertible Preferred Stock | Â (4) | 07/02/2020 | Series C Convertible Preferred Stock (5) | 109,015 (5) | $ 0.7338 (6) | I | See footnote (3) |
Warrant to Purchase Series C Convertible Preferred Stock | Â (4) | 12/29/2020 | Series C Convertible Preferred Stock (5) | 54,507 (5) | $ 0.7338 (6) | I | See footnote (3) |
Convertible Promissory Note | Â (7) | 07/01/2017 | Common Stock | 3,387,146 (2) | $ (7) | I | See footnote (3) |
Convertible Promissory Note | Â (7) | 07/01/2017 | Common Stock | 1,999,898 (2) | $ (7) | I | See footnote (3) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Eastman Ronald W C/O ESSEX WOODLANDS HEALTH VENTURES 335 BRYANT STREET, THIRD FLOOR PALO ALTO, CA 94301 |
 X |  X |  |  |
/s/Lowell Segal, Attorney-in-Fact | 04/02/2014 | |
**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 shares of Series B Convertible Preferred Stock and Series C Convertible Preferred Stock have no expiration date and are convertible at any time at the election of the holder and will automatically convert into shares of Common Stock in connection with the Issuer's initial public offering. |
(2) | The number of shares reflets a 10.1-for-1-reverse stock split of all outstanding shares of Common Stock effected on March 21, 2014. |
(3) | The securities are held of record by Essex Woodlands Health Ventures Fund VII, L.P. (the "Fund"). The Reporting Person may be deemed to share voting and investment power over securities held by the Fund. |
(4) | The warrants may be exercised at any time at the election of the holder and will automatically net exercise in connection with the Issuer's initial public offering. |
(5) | Upon conversion of the Series C Convertible Preferred Stock into Common Stock in connection with the Issuer's initial public offering, the underlying shares will be subject to a 10.1-for-1 reverse stock split of all outstanding shares of Common Stock effected on March 21, 2014. |
(6) | Upon conversion of the Series C Convertible Preferred Stock into Common Stock in connection with the Issuer's initial public offering, the exercise price will be adjusted to reflect a 10.1-for-1 reverse stock split of all outstanding shares of Common Stock effected on March 21, 2014. |
(7) | The principal amount and accrued interest will automatically convert into the specified number of shares of Common Stock in connection with the Issuer's initial public offering. |
 Remarks: Exhibit List - Exhibit 24 - Power of Attorney |