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 B Convertible Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
87,470
(2)
|
$
(1)
|
D
|
Â
|
Series B Convertible Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
8,020
|
$
(1)
|
I
|
By Viram Foundation
(3)
|
Series B Convertible Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
5,488
|
$
(1)
|
I
|
By Mehta Partners LLC
(4)
|
Series B Convertible Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
1,245
|
$
(1)
|
I
|
By Mehta Partners LLC FBO Jean Kiss Marie IRA
(5)
|
Series C Convertible Preferred Stock
|
Â
(6)
|
Â
(6)
|
Common Stock
|
1,030
|
$
(6)
|
I
|
By Viram Foundation
(3)
|
Series C Convertible Preferred Stock
|
Â
(6)
|
Â
(6)
|
Common Stock
|
2,270
|
$
(6)
|
I
|
By Mehta Partners LLC
(4)
|
Series C Convertible Preferred Stock
|
Â
(6)
|
Â
(6)
|
Common Stock
|
460
|
$
(6)
|
I
|
By Mehta Partners LLC FBO Jean Kiss Marie IRA
(5)
|
Series D Convertible Preferred Stock
|
Â
(7)
|
Â
(7)
|
Common Stock
|
1,007
|
$
(7)
|
I
|
By Viram Foundation
(3)
|
Series D Convertible Preferred Stock
|
Â
(7)
|
Â
(7)
|
Common Stock
|
2,296
|
$
(7)
|
I
|
By Mehta Partners LLC
(4)
|
Series D Convertible Preferred Stock
|
Â
(7)
|
Â
(7)
|
Common Stock
|
451
|
$
(7)
|
I
|
By Mehta Partners LLC FBO Jean Kiss Marie IRA
(5)
|
Series E Convertible Preferred Stock
|
Â
(8)
|
Â
(8)
|
Common Stock
|
10,246
|
$
(8)
|
D
|
Â
|
Series I Convertible Preferred Stock
|
Â
(9)
|
Â
(9)
|
Common Stock
|
22,771
(10)
|
$
(9)
|
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 convertible preferred stock is convertible at any time, at the holder's election, and is automatically convertible immediately prior to the consummation of the Issuer's initial public offering on a 0.85-for-1 basis and has no expiration date. |
(2) |
Includes 13,454 shares held jointly with spouse. |
(3) |
The reporting person is trustee of Viram Foundation. |
(4) |
The reporting person is managing member of Mehta Partners LLC. |
(5) |
The reporting Person is trustee of Mehta Partners LLC FBO Jean Kiss Marie IRA. |
(6) |
The convertible preferred stock is convertible at any time, at the holder's election, and is automatically convertible immediately prior to the consummation of the Issuer's initial public offering on a 0.75-for-1 basis and has no expiration date. |
(7) |
The convertible preferred stock is convertible at any time, at the holder's election, and is automatically convertible immediately prior to the consummation of the Issuer's initial public offering on a 0.75-for-1 basis and has no expiration date. |
(8) |
The convertible preferred stock is convertible at any time, at the holder's election, and is automatically convertible immediately prior to the consummation of the Issuer's initial public offering on a 0.75-for-1 basis and has no expiration date. |
(9) |
The convertible preferred stock is convertible at any time, at the holder's election, and is automatically convertible immediately prior to the consummation of the Issuer's initial public offering on a 0.75-for-1 basis and has no expiration date. |
(10) |
Shares held jointly with spouse. |