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 |
Stock Option (right to buy)
|
Â
(6)
|
09/24/2017 |
Common Stock
|
7,500
|
$
7.2
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(6)
|
09/24/2017 |
Common Stock
|
15,000
|
$
7.2
|
D
|
Â
|
Series B Convertible Preferred Stock
|
Â
(7)
|
Â
(7)
|
Common Stock
|
97,819
|
$
(7)
|
I
|
See footnotes
(1)
|
Series B Convertible Preferred Stock
|
Â
(7)
|
Â
(7)
|
Common Stock
|
343,223
|
$
(7)
|
I
|
See footnotes
(2)
|
Series B Convertible Preferred Stock
|
Â
(7)
|
Â
(7)
|
Common Stock
|
343,957
|
$
(7)
|
I
|
See footnotes
(3)
|
Series B Convertible Preferred Stock
|
Â
(7)
|
Â
(7)
|
Common Stock
|
34,014
|
$
(7)
|
I
|
See footnotes
(4)
|
Series B Convertible Preferred Stock
|
Â
(7)
|
Â
(7)
|
Common Stock
|
881,655
|
$
(7)
|
I
|
See footnotes
(5)
|
Series C Convertible Preferred Stock
|
Â
(8)
|
Â
(8)
|
Common Stock
|
9,370
|
$
(8)
|
I
|
See footnotes
(1)
|
Series C Convertible Preferred Stock
|
Â
(8)
|
Â
(8)
|
Common Stock
|
655,261
|
$
(8)
|
I
|
See footnotes
(9)
|
Series C Convertible Preferred Stock
|
Â
(8)
|
Â
(8)
|
Common Stock
|
32,877
|
$
(8)
|
I
|
See footnotes
(2)
|
Series C Convertible Preferred Stock
|
Â
(8)
|
Â
(8)
|
Common Stock
|
32,948
|
$
(8)
|
I
|
See footnotes
(3)
|
Series C Convertible Preferred Stock
|
Â
(8)
|
Â
(8)
|
Common Stock
|
351
|
$
(8)
|
I
|
See footnotes
(4)
|
Series C Convertible Preferred Stock
|
Â
(8)
|
Â
(8)
|
Common Stock
|
53,721
|
$
(8)
|
I
|
See footnotes
(10)
|
Series C Convertible Preferred Stock
|
Â
(8)
|
Â
(8)
|
Common Stock
|
223,839
|
$
(8)
|
I
|
See footnotes
(11)
|
Series C Convertible Preferred Stock
|
Â
(8)
|
Â
(8)
|
Common Stock
|
60,374
|
$
(8)
|
I
|
See footnotes
(12)
|
Series C Convertible Preferred Stock
|
Â
(8)
|
Â
(8)
|
Common Stock
|
327,596
|
$
(8)
|
I
|
See footnotes
(13)
|
Series C Convertible Preferred Stock
|
Â
(8)
|
Â
(8)
|
Common Stock
|
84,454
|
$
(8)
|
I
|
See footnotes
(5)
|
Series C Convertible Preferred Stock
|
Â
(8)
|
Â
(8)
|
Common Stock
|
369,209
|
$
(8)
|
I
|
See footnotes
(14)
|
Series C Convertible Preferred Stock
|
Â
(8)
|
Â
(8)
|
Common Stock
|
7,143
|
$
(8)
|
I
|
See footnotes
(15)
|
Series D Convertible Preferred Stock
|
Â
(16)
|
Â
(16)
|
Common Stock
|
11,281
|
$
(16)
|
I
|
See footnotes
(10)
|
Series D Convertible Preferred Stock
|
Â
(16)
|
Â
(16)
|
Common Stock
|
47,006
|
$
(16)
|
I
|
See footnotes
(11)
|
Series D Convertible Preferred Stock
|
Â
(16)
|
Â
(16)
|
Common Stock
|
12,679
|
$
(16)
|
I
|
See footnotes
(12)
|
Series D Convertible Preferred Stock
|
Â
(16)
|
Â
(16)
|
Common Stock
|
77,534
|
$
(16)
|
I
|
See footnotes
(14)
|
Series D Convertible Preferred Stock
|
Â
(16)
|
Â
(16)
|
Common Stock
|
1,500
|
$
(16)
|
I
|
See footnotes
(15)
|
* |
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) |
By Sanderling [Feri Trust] Venture Partners IV, L.P. Fred Middleton, a member of the Issuer's board of directors is a general partner of Middleton-McNeil Investment Partners IV, L.P. the sole general partner of Sanderling [Feri Trust] Venture Partners IV, L.P. and has voting and investment power over the shares held by Sanderling [Feri Trust] Venture Partners IV, L.P. Mr. Middleton disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
(2) |
By Sanderling IV Biomedical, L.P. Fred Middleton, a member of the Issuer's board of directors is a managing director of Middleton, McNeil & Mills Associates IV, LLC the sole general partner of Sanderling IV Biomedical, L.P. and has voting and investment power over the shares held by Sanderling IV Biomedical, L.P. Mr. Middleton disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
(3) |
By Sanderling IV Limited Partnership. Fred Middleton, a member of the Issuer's board of directors is a general partner of Middleton-McNeil IV, L.P. the sole general partner of Sanderling IV Limited Partnership and has voting and investment power over the shares held by Sanderling IV Limited Partnership. Mr. Middleton disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
(4) |
By Sanderling Ventures Management IV. Fred Middleton, a member of the Issuer's board of directors is an owner of Sanderling Ventures Management IV and has voting and investment power over the shares held by Sanderling Ventures Management IV. Mr. Middleton disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
(5) |
By Sanderling Venture Partners IV, L.P. Fred Middleton, a member of the Issuer's board of directors is a general partner of Middleton-McNeil Associates IV, L.P. the sole general partner of Sanderling Venture Partners IV, L.P. and has voting and investment power over the shares held by Sanderling Venture Partners IV, L.P. Mr. Middleton disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
(6) |
33 1/3 % of the shares subject to the option shall vest on the first anniversary of the vesting start date of 9/24/07; 1/24th shall vest on each monthly anniversary thereafter. The options may be early exercised prior to vesting but any exercised and unvested shares are subject to a right of repurchase on behalf of the Issuer. |
(7) |
Series B Preferred Stock has no expiration date and is convertible at any time at the option of the holder and will automatically convert upon the closing of the Issuer's initial public offering, at a conversion ratio of one share of Common Stock for every two shares of Series B Preferred Stock, for no additional consideration. |
(8) |
Series C Preferred Stock has no expiration date and is convertible at any time at the option of the holder and will automatically convert upon the closing of the Issuer's initial public offering, at a conversion ratio of one share of Common Stock for every two shares of Series C Preferred Stock, for no additional consideration. |
(9) |
By Sanderling IV Biomedical Co-Investment Fund, L.P. Fred Middleton, a member of the Issuer's board of directors is a managing director of Middleton, McNeil & Mills Associates IV, LLC the sole general partner of Sanderling IV Biomedical Co-Investment Fund, L.P. and has voting and investment power over the shares held by Sanderling IV Biomedical Co-Investment Fund, L.P. Mr. Middleton disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
(10) |
By Sanderling V Beteilingungs GmbH & Co KG. Fred Middleton, a member of the Issuer's board of directors is a managing director of Middleton, McNeil & Mills Associates V, LLC the sole general partner of Sanderling V Beteilingungs GmbH & Co KG and has voting and investment power over the shares held by Sanderling V Beteilingungs GmbH & Co KG. Mr. Middleton disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
(11) |
By Sanderling V Biomedical Co-Investment Fund L.P. Fred Middleton, a member of the Issuer's board of directors is a managing director of Middleton, McNeil & Mills Associates V, LLC the sole general partner of Sanderling V Biomedical Co-Investment Fund L.P and has voting and investment power over the shares held by Sanderling V Biomedical Co-Investment Fund L.P. Mr. Middleton disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
(12) |
By Sanderling V Limited Partnership. Fred Middleton, a member of the Issuer's board of directors is a managing director of Middleton, McNeil & Mills Associates V, LLC the sole general partner of Sanderling V Limited Partnership and has voting and investment power over the shares held by Sanderling V Limited Partnership. Mr. Middleton disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
(13) |
By Sanderling Venture Partners IV Co-Investment Fund, L.P. Fred Middleton, a member of the Issuer's board of directors is a managing director of Middleton, McNeil & Mills Associates IV, LLC the sole general partner of Sanderling Venture Partners IV Co-Investment Fund, L.P and has voting and investment power over the shares held by Sanderling Venture Partners IV Co-Investment Fund, L.P. Mr. Middleton disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
(14) |
By Sanderling Venture Partners V Co-Investment Fund, L.P. Fred Middleton, a member of the Issuer's board of directors is a managing director of Middleton, McNeil & Mills Associates V, LLC the sole general partner of Sanderling Venture Partners V Co-Investment Fund, L.P and has voting and investment power over the shares held by Sanderling Venture Partners V Co-Investment Fund, L.P. Mr. Middleton disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
(15) |
By Sanderling Ventures Management V. Fred Middleton, a member of the Issuer's board of directors is an owner of Sanderling Ventures Management V and has voting and investment power over the shares held by Sanderling Ventures Management V. Mr. Middleton disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
(16) |
Series D Preferred Stock has no expiration date and is convertible at any time at the option of the holder and will automatically convert upon the closing of the Issuer's initial public offering, at a conversion ratio of one share of Common Stock for every two shares of Series D Preferred Stock, for no additional consideration. |