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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 | ||||||||
| Common Stock Warrant (right to buy) | $ 0.2 | 05/07/2014 | X | 4,551 | 12/07/2011 | 12/06/2016 | Common Stock | 4,551 | $ 0 | 0 | D (1) | ||||
| Common Stock Warrant (right to buy) | $ 0.2 | 05/07/2014 | X | 4,551 | 05/15/2012 | 05/14/2017 | Common Stock | 4,551 | $ 0 | 0 | D (1) | ||||
| Common Stock Warrant (right to buy) | $ 0.2 | 05/07/2014 | X | 82,454 | 12/11/2013 | 12/10/2018 | Common Stock | 82,454 | $ 0 | 0 | D (1) | ||||
| Series C Preferred Stock | (3) | 05/07/2014 | C | 570,159 | (3) | (3) | Common Stock | 161,238 | $ 0 | 0 | D (1) | ||||
| Series D-1 Preferred Stock | (4) | 05/07/2014 | C | 1,024,876 | (4) | (4) | Common Stock | 50,239 | $ 0 | 0 | D (1) | ||||
| Series D-2 Preferred Stock | (5) | 05/07/2014 | C | 1,417,315 | (5) | (5) | Common Stock | 69,476 | $ 0 | 0 | D (1) | ||||
| Common Stock Warrant (right to buy) | $ 0.2 | 05/07/2014 | X | 174 | 12/07/2011 | 12/06/2016 | Common Stock | 174 | $ 0 | 0 | I | By Alta Embarcadero BioPharma Partners II, LLC (1) (2) | |||
| Common Stock Warrant (right to buy) | $ 0.2 | 05/07/2014 | X | 174 | 05/15/2012 | 05/14/2017 | Common Stock | 174 | $ 0 | 0 | I | By Alta Embarcadero BioPharma Partners II, LLC (1) (2) | |||
| Common Stock Warrant (right to buy) | $ 0.2 | 05/07/2014 | X | 3,033 | 12/11/2013 | 12/10/2018 | Common Stock | 3,033 | $ 0 | 0 | I | By Alta Embarcadero BioPharma Partners II, LLC (1) (2) | |||
| Series C Preferred Stock | (3) | 05/07/2014 | C | 20,975 | (3) | (3) | Common Stock | 5,931 | $ 0 | 0 | I | By Alta Embarcadero BioPharma Partners II, LLC (1) (2) | |||
| Series D-1 Preferred Stock | (4) | 05/07/2014 | C | 37,702 | (4) | (4) | Common Stock | 1,848 | $ 0 | 0 | I | By Alta Embarcadero BioPharma Partners II, LLC (1) (2) | |||
| Series D-2 Preferred Stock | (5) | 05/07/2014 | C | 53,915 | (5) | (5) | Common Stock | 2,642 | $ 0 | 0 | I | By Alta Embarcadero BioPharma Partners II, LLC (1) (2) | |||
| Reporting Owner Name / Address | Relationships | |||
| Director | 10% Owner | Officer | Other | |
| ALTA BIOPHARMA PARTNERS II LP ONE EMBARCADERO CENTER, 37TH FLOOR SAN FRANCISCO, CA 94111 |
X | |||
| ALTA BIOPHARMA MANAGEMENT II LLC ONE EMBARCADERO CENTER, 37TH FLOOR SAN FRANCISCO, CA 94111 |
X | |||
| ALTA EMBARCADERO BIOPHARMA PARTNERS II LLC ONE EMBARCADERO CENTER, 37TH FLOOR SAN FRANCISCO, CA 94111 |
X | |||
| CHAMPSI FARAH ONE EMBARCADERO CENTER, 37TH FLOOR SAN FRANCISCO, CA 94111 |
X | |||
| By: /s/ Farah Champsi, Managing Director | 05/08/2014 | |
| **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) | Farah Champsi (known as the "Principal") is the managing director of Alta BioPharma Management II, LLC ("ABM II") (which is the general partner of Alta BioPharma Partners II, L.P. ("ABP II")), and manager of Alta Embarcadero BioPharma Partners II, LLC ("AEBP II"). As managing director and manager of such entities, Ms. Champsi may be deemed to have voting and investment power for the shares held by ABP II and AEBP II. The Principal disclaims beneficial ownership of all such shares held by ABP II and AEBP II, except to the extent of her proportionate pecuniary interests therein. |
| (2) | These securities are held by AEBP II. |
| (3) | Upon closing of the Issuer's initial public offering, each share of Series C Preferred Stock converted automatically into shares of common stock of the Issuer on a 1-for-3.536 basis, and had no expiration date. |
| (4) | Upon closing of the Issuer's initial public offering, each share of Series D-1 Preferred Stock converted automatically into shares of common stock of the Issuer on a 1-for-20.4 basis, and had no expiration date. |
| (5) | Upon closing of the Issuer's initial public offering, each share of Series D-2 Preferred Stock converted automatically into shares of common stock of the Issuer on a 1-for-20.4 basis, and had no expiration date. |