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
(2)
|
Â
(2)
|
Common Stock
|
356,703
(3)
|
$
0
(2)
|
I
|
By Versant Development Fund III, LLC
(1)
|
Stock option (right to buy)
|
Â
(4)
|
09/23/2019 |
Common Stock
|
15,369
|
$
0.1626
|
D
|
Â
|
Stock option (right to buy)
|
Â
(5)
|
08/28/2022 |
Common Stock
|
136,530
|
$
2.5203
|
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) |
Shares held by Versant Development Fund III, LLC. The Reporting Person is a manager and minority member of Versant Development Fund III, LLC. The Reporting Person disclaims any beneficial ownership of the shares held by Versant Development Fund III, LLC except to the extent of his pecuniary interest in these shares. |
(2) |
The shares of Series A Preferred Stock have no expiration date and are convertible at any time at the election of the holder without payment of further consideration. Each share of Series A Preferred Stock will automatically convert on a 1-for-8.13 basis into shares of Common Stock upon the closing of the Issuer's initial public offering. |
(3) |
Share numbers assume or give effect to the 1-for-8.13 reverse stock split of the Issuer's Common Stock effected on January 27, 2014, which will be effective for the Preferred Stock upon its conversion to Common Stock immediately prior to the closing of the Issuer's initial public offering. |
(4) |
The stock option is fully vested and exercisable. |
(5) |
1/4 of the shares subject to the option vest one year after August 29, 2012, with 1/48th of the shares vesting monthly thereafter over the next 3 years. |