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 |
Stock Option (Right to Buy)
|
Â
(1)
|
08/02/2014 |
Common Stock
|
11,000
|
$
15
|
D
|
Â
|
Stock Purchase Warrant (Right to Buy)
|
10/01/2003 |
09/29/2010 |
Common Stock
|
2,069
|
$
10
|
D
|
Â
|
Stock Purchase Warrant (Right to Buy)
|
01/30/2004 |
01/28/2011 |
Common Stock
|
505
|
$
10
|
D
|
Â
|
Stock Purchase Warrant (Right to Buy)
|
01/30/2004 |
01/28/2011 |
Common Stock
|
708
|
$
10
|
D
|
Â
|
Series A Preferred Stock
|
Â
(2)
|
Â
(3)
|
Common Stock
|
11,388
(4)
|
$
(4)
|
D
|
Â
|
Series D Preferred Stock
|
Â
(2)
|
Â
(3)
|
Common Stock
|
10,025
(5)
|
$
(5)
|
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 option vests in four equal installments on each of August 2, 2005, 2006, 2007 and 2008, and may be exercised prior to vesting, subject to certain rights of repurchase by the Issuer. |
(2) |
These shares of Preferred Stock will automatically convert into shares of Common Stock upon the closing of the Issuer's initial public offering. |
(3) |
Not applicable. |
(4) |
These shares of Preferred Stock will automatically convert into Common Stock upon the closing of the Issuer's initial public offering, and reflect a 2.75/2.63 conversion ratio, as adjusted to reflect a 6-for-10 and subsequent 1-for-3 reverse stock split. |
(5) |
These shares of Preferred Stock will automatically convert into Common Stock upon the closing of the Issuer's initial public offering, and reflect a 2.75/2.00 conversion ratio, as adjusted to reflect a 6-for-10 and subsequent 1-for-3 reverse stock split. |