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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 Convertible Preferred Stock | (1) | 10/04/2013 | C | 651,806 | (1) | (1) | Common Stock | 651,806 | $ 0 | 0 | I | By Polaris Venture Partners V, L.P. (3) | |||
Series A Convertible Preferred Stock | (1) | 10/04/2013 | C | 12,704 | (1) | (1) | Common Stock | 12,704 | $ 0 | 0 | I | By Polaris Venture Partners Entrepreneurs' Fund V, L.P. (4) | |||
Series A Convertible Preferred Stock | (1) | 10/04/2013 | C | 4,465 | (1) | (1) | Common Stock | 4,465 | $ 0 | 0 | I | By Polaris Venture Partners Founders' Fund V, L.P. (5) | |||
Series A Convertible Preferred Stock | (1) | 10/04/2013 | C | 6,518 | (1) | (1) | Common Stock | 6,518 | $ 0 | 0 | I | By Polaris Venture Partners Special Founders' Fund V, L.P. (6) | |||
Series B Convertible Preferred Stock | (2) | 10/04/2013 | C | 222,677 | (2) | (2) | Common Stock | 255,950 | $ 0 | 0 | I | By Polaris Venture Partners V, L.P. (3) | |||
Series B Convertible Preferred Stock | (2) | 10/04/2013 | C | 4,340 | (2) | (2) | Common Stock | 4,988 | $ 0 | 0 | I | By Polaris Venture Partners Entrepreneurs' Fund V, L.P. (4) | |||
Series B Convertible Preferred Stock | (2) | 10/04/2013 | C | 1,525 | (2) | (2) | Common Stock | 1,753 | $ 0 | 0 | I | By Polaris Venture Partners Founders' Fund V, L.P. (5) | |||
Series B Convertible Preferred Stock | (2) | 10/04/2013 | C | 2,227 | (2) | (2) | Common Stock | 2,560 | $ 0 | 0 | I | By Polaris Venture Partners Special Founders' Fund V, L.P. (6) | |||
Series C Convertible Preferred Stock | (1) | 10/04/2013 | C | 550,653 | (1) | (1) | Common Stock | 550,653 | $ 0 | 0 | I | By Polaris Venture Partners V, L.P. (3) | |||
Series C Convertible Preferred Stock | (1) | 10/04/2013 | C | 10,732 | (1) | (1) | Common Stock | 10,732 | $ 0 | 0 | I | By Polaris Venture Partners Entrepreneurs' Fund V, L.P. (4) | |||
Series C Convertible Preferred Stock | (1) | 10/04/2013 | C | 3,772 | (1) | (1) | Common Stock | 3,772 | $ 0 | 0 | I | By Polaris Venture Partners Founders' Fund V, L.P. (5) | |||
Series C Convertible Preferred Stock | (1) | 10/04/2013 | C | 5,506 | (1) | (1) | Common Stock | 5,506 | $ 0 | 0 | I | By Polaris Venture Partners Special Founders' Fund V, L.P. (6) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Nashat Amir C/O POLARIS VENTURE PARTNERS 1000 WINTER STREET, SUITE 3350 WALTHAM, MA 02451 |
X | X |
/s/ Amir Nashat | 10/04/2013 | |
**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) | The aggregate number of shares of Issuer's Preferred Stock held by the Reporting Persons converted into Common Stock immediately prior to the closing of the Issuer's initial public offering and has no expiration date. These shares converted into Common Stock on a 1-for-1 basis. |
(2) | The aggregate number of shares of Issuer's Preferred Stock held by the Reporting Persons converted into Common Stock immediately prior to the closing of the Issuer's initial public offering and has no expiration date. These shares converted into Common Stock on approximately a 1-for-1.15 basis. |
(3) | These shares are owned directly by Polaris Venture Partners V, L.P., whose sole general partner is Polaris Venture Management Co. V, LLC ("Polaris Management"). The members of North Star Venture Management 2010 LLC are also members of Polaris Management, and as members of the general partner, they may be deemed to share voting and investment power of such shares. The Reporting Person is a member of Polaris Management and has shared voting and investment power over such shares and may be deemed the indirect beneficial owner of such shares. The Reporting Person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for Section 16 or any other purpose. |
(4) | These shares are owned directly by Polaris Venture Partners Entrepreneurs' Fund V, L.P., whose sole general partner is Polaris Management. The members of North Star Venture Management 2010 LLC are also members of Polaris Management, and as members of the general partner, they may be deemed to share voting and investment power of such shares. The Reporting Person is a member of Polaris Management and has shared voting and investment power over such shares and may be deemed the indirect beneficial owner of such shares. The Reporting Person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for Section 16 or any other purpose. |
(5) | These shares are owned directly by Polaris Venture Partners Founders' Fund V, L.P., whose sole general partner is Polaris Management. The members of North Star Venture Management 2010 LLC are also members of Polaris Management, and as members of the general partner, they may be deemed to share voting and investment power of such shares. The Reporting Person is a member of Polaris Management and has shared voting and investment power over such shares and may be deemed the indirect beneficial owner of such shares. The Reporting Person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for Section 16 or any other purpose. |
(6) | These shares are owned directly by Polaris Venture Partners Special Founders' Fund V, L.P., whose sole general partner is Polaris Management. The members of North Star Venture Management 2010 LLC are also members of Polaris Management, and as members of the general partner, they may be deemed to share voting and investment power of such shares. The Reporting Person is a member of Polaris Management and has shared voting and investment power over such shares and may be deemed the indirect beneficial owner of such shares. The Reporting Person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for Section 16 or any other purpose. |
(7) | The shares were acquired upon conversion of a convertible promissory note exempt from the definition of a derivative security because the conversion price did not become fixed until automatic conversion at the time of the closing of the Issuer's initial public offering. |