UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF 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. | SEC 1473 (7-02) | ||
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. |
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) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series A Preferred Stock | Â (1) | Â (1) | Common Stock | 967,741 (1) | $ (1) | I | See Footnotes (2) (3) |
Series B Preferred Stock | Â (1) | Â (1) | Common Stock | 677,419 (1) | $ (1) | I | See Footnotes (2) (4) |
Series C Preferred Stock | Â (1) | Â (1) | Common Stock | 504,032 (1) | $ (1) | I | See Footnotes (2) (5) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HealthCare Ventures VIII, L.P. C/O HEALTHCARE VENTURES LLC, 47 THORNDIKE STREET, SUITE B1-1 CAMBRIDGE, MA 02141 |
 |  X |  |  |
HealthCare Partners VIII, L.P. C/O HEALTHCARE VENTURES LLC, 47 THORNDIKE STREET, SUITE B1-1 CAMBRIDGE, MA 02141 |
 |  X |  |  |
HealthCare Partners VIII, LLC C/O HEALTHCARE VENTURES LLC, 47 THORNDIKE STREET, SUITE B1-1 CAMBRIDGE, MA 02141 |
 |  X |  |  |
CAVANAUGH JAMES H C/O HEALTHCARE VENTURES LLC, 47 THORNDIKE STREET, SUITE B1-1 CAMBRIDGE, MA 02141 |
 |  X |  |  |
Mirabelli Christopher C/O HEALTHCARE VENTURES LLC, 47 THORNDIKE STREET, SUITE B1-1 CAMBRIDGE, MA 02141 |
 X |  X |  |  |
LAWLOR AUGUSTINE C/O HEALTHCARE VENTURES LLC, 47 THORNDIKE STREET, SUITE B1-1 CAMBRIDGE, MA 02141 |
 |  X |  |  |
LITTLECHILD JOHN W C/O HEALTHCARE VENTURES LLC, 47 THORNDIKE STREET, SUITE B1-1 CAMBRIDGE, MA 02141 |
 |  X |  |  |
WERNER HAROLD R C/O HEALTHCARE VENTURES LLC 47 THORNDIKE STREET, SUITE B1-1 CAMBRIDGE, MA 02141 |
 |  X |  |  |
/s/Jeffrey B. Steinberg, Administrative Partner of HealthCare Ventures VIII, L.P. | 01/30/2014 | |
**Signature of Reporting Person | Date | |
Jeffrey B. Steinberg, Administrative Partner of HealthCare Partners VIII, L.P. | 01/30/2014 | |
**Signature of Reporting Person | Date | |
Jeffrey B. Steinberg, Administrative Officer of HealthCare Partners VIII LLC | 01/30/2014 | |
**Signature of Reporting Person | Date | |
Jeffrey B. Steinberg, Attorney-in-Fact for James H. Cavanaugh | 01/30/2014 | |
**Signature of Reporting Person | Date | |
Jeffrey B. Steinberg, Attorney-in-Fact for Christopher Mirabelli | 01/30/2014 | |
**Signature of Reporting Person | Date | |
Jeffrey B. Steinberg, Attorney-in-Fact for Augustine Lawlor | 01/30/2014 | |
**Signature of Reporting Person | Date | |
Jeffrey B. Steinberg, Attorney-in-Fact for John Littlechild | 01/30/2014 | |
**Signature of Reporting Person | Date | |
Jeffrey B. Steinberg, Attorney-in-Fact for Harold Werner | 01/30/2014 | |
**Signature of Reporting Person | Date |
* | 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) | Immediately prior to closing of the issuer's initial public offering, the preferred stock held by the reporting persons will automatically convert into common stock on a 6.2 to 1 basis. |
(2) | The securities are held of record by HealthCare Ventures VIII, L.P. ("HCVVIII"). HealthCare Partners VIII, L.P. ("HCPVIII") is the General Partner of HCVVIII and HealthCare Partners VIII LLC (the "LLC") is the General Partner of HCPVIII. Each of James Cavanaugh, Harold Werner, John Littlechild, Christopher Mirabelli and Augustine Lawlor are the managing directors of the LLC and exercise shared voting and investment power with respect to the shares owned by HCVVIII. Each of the reporting persons disclaims beneficial ownership of such securities, except to the extent of their proportionate pecuniary interest therein. Dr. Mirabelli is also a director of the issuer. |
(3) | HCVVIII holds an aggregate of 6,000,000 shares of Series A Preferred Stock which is convertible into 967,740 shares of Common Stock. |
(4) | HCVVIII holds an aggregate of 4,200,000 shares of Series B Preferred Stock which is convertible into 677,419 shares of Common Stock. |
(5) | HCVVIII holds an aggregate of 3,125,000 shares of Series C Preferred Stock which is convertible into 504,032 shares of Common Stock. |