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 Preferred Stock
|
Â
(3)
|
Â
(3)
|
Common Stock
|
82,043
|
$
0
(3)
|
I
|
Held by the Wiggans Living Trust dated 5/14/02
(1)
|
Series C Preferred Stock
|
Â
(3)
|
Â
(3)
|
Common Stock
|
25,965
|
$
0
(3)
|
I
|
Held by the Wiggans Living Trust dated 5/14/02
(1)
|
Employee Stock Option (right to buy)
|
Â
(4)
|
10/03/2021 |
Common Stock
|
253,642
|
$
0.986
|
D
|
Â
|
Employee Stock Option (right to buy)
|
Â
(5)
|
01/03/2023 |
Common Stock
|
184,349
|
$
1.218
|
D
|
Â
|
Employee Stock Option (right to buy)
|
Â
(5)
|
07/10/2023 |
Common Stock
|
98,430
|
$
1.74
|
D
|
Â
|
* |
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 Reporting Person is a Co-Trustee. |
(2) |
The Reporting Person has no voting or dispositive power over the shares held by the trust. |
(3) |
Each share of Preferred Stock will be automatically converted into one (1) share of Common Stock, for no additional consideration, immediately prior to the consummation of the Issuer's initial public offering, and has no expiration date. |
(4) |
The stock option vests and becomes exercisable in 48 equal monthly installments beginning one month after the vesting commencement date, until such time as the option is 100% vested, subject to the continuing employment of the Reporting Person on each vesting date. |
(5) |
The stock option vests and becomes exercisable as to 25% of the shares subject to the option on the one-year anniversary of the vesting commencement date, and thereafter vests as to 1/48th of the shares in equal monthly installments, subject to the continuing employment of the Reporting Person on each vesting date. |