|
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 |
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
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) |
||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series C-3 Convertible Preferred Stock | (1) | 02/09/2011 | C | 17,451 | (1) | (1) | Common Stock | 17,451 | (1) | 0 | D | ||||
Series B Convertible Preferred Stock | (1) | 02/09/2011 | C | 184,785 | (1) | (1) | Common Stock | 184,785 | (1) | 0 | I | By ABV Holding Company 7 LLC (4) | |||
Series C-1 Convertible Preferred Stock | (1) | 02/09/2011 | C | 187,126 | (1) | (1) | Common Stock | 187,126 | (1) | 0 | I | By ABV Holding Company 7 LLC (4) | |||
Series C-1 Convertible Preferred Stock | (1) | 02/09/2011 | C | 137,973 | (1) | (1) | Common Stock | 137,973 | (1) | 0 | I | By ABV Holding Company 9 LLC (5) | |||
Series C-2 Convertible Preferred Stock | (1) | 02/09/2011 | C | 83,769 | (1) | (1) | Common Stock | 83,769 | (1) | 0 | I | By ABV Holding Company 10 LLC (6) | |||
Series C-3 Convertible Preferred Stock | (1) | 02/09/2011 | C | 366,490 | (1) | (1) | Common Stock | 366,490 | (1) | 0 | I | By ABV Holding Company 12 LLC (7) | |||
Subordinated Convertible Promissory Note | (8) | 02/09/2011 | C | $ 1,413,041.1 (8) | (8) | (8) | Common Stock | 277,066 | (8) | 0 | I | By ABV Holding Company 13 LLC (9) | |||
Stock Option (right to buy) | $ 7.23 | 02/09/2011 | A | 15,706 | (10) | 02/09/2021 | Common Stock | 15,706 | $ 0 | 15,706 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
BAILEY DOUGLAS G 120 LONG RIDGE ROAD STAMFORD, CT 06902 |
X |
/s/ Douglas G. Bailey | 02/11/2011 | |
**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) | Each share of the Issuer's Series A-1, Series A-2, Series B, Series C-1, Series C-2 and Series C-3 Preferred Stock automatically converted into shares of Common Stock on a one-for-one basis upon the closing of the Issuer's initial public offering and has no expiration date. |
(2) | 29,668 shares held by Douglas G. Bailey are subject to repurchase based on milestones set forth in the Restricted Stock Purchase Agreement dated July 10, 2001 between the Issuer and each of Sanderling Venture Partners V, L.P., Sanderling V Biomedical, L.P., ABV Holding Company 7 LLC, Douglas G. Bailey, and Cincinnati Financial Corporation. |
(3) | 44,502 shares held by ABV Holding Company 7 LLC are subject to repurchase based on milestones set forth in the Restricted Stock Purchase Agreement dated July 10, 2001 between the Issuer and each of Sanderling Venture Partners V, L.P., Sanderling V Biomedical, L.P., ABV Holding Company 7 LLC, Douglas G. Bailey, and Cincinnati Financial Corporation. |
(4) | Douglas G. Bailey is a Managing Member of ABV Holding Company 7 LLC. Mr. Bailey disclaims beneficial ownership of the shares directly held by the entities affiliated with ABV Holding Company except to the extent of his pecuniary interest therein. |
(5) | Douglas G. Bailey is a Managing Member of ABV Holding Company 9 LLC. Mr. Bailey disclaims beneficial ownership of the shares directly held by the entities affiliated with ABV Holding Company except to the extent of his pecuniary interest therein. |
(6) | Douglas G. Bailey is a Managing Member of ABV Holding Company 10 LLC. Mr. Bailey disclaims beneficial ownership of the shares directly held by the entities affiliated with ABV Holding Company except to the extent of his pecuniary interest therein. |
(7) | Douglas G. Bailey is a Managing Member of ABV Holding Company 12 LLC. Mr. Bailey disclaims beneficial ownership of the shares directly held by the entities affiliated with ABV Holding Company except to the extent of his pecuniary interest therein. |
(8) | The outstanding principal amount of the reported securities and all accrued and unpaid interest automatically converted upon the closing of the Issuer's initial public offering at 85% of the original issue price of the shares of the Issuer's initial public offering. |
(9) | Douglas G. Bailey is a Managing Member of ABV Holding Company 13 LLC. Mr. Bailey disclaims beneficial ownership of the shares directly held by the entities affiliated with ABV Holding Company except to the extent of his pecuniary interest therein. |
(10) | Shares subject to the option vest 1/3 of the shares upon the business day before each of the Issuer's first three annual stockholder meetings following February 9, 2011. |