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 C Convertible Preferred Stock | Â (1) | Â (2) | Common Stock | 809,209 (1) | $ 0 (1) | I | By SPVC V, LLC (3) |
Series E Convertible Preferred Stock | Â (1) | Â (2) | Common Stock | 786,652 (1) | $ 0 (1) | I | By SPVC VI, LLC (4) |
Common Stock Warrant (right to buy) | 12/31/2002 | 06/27/2012 | Common Stock | 141,597 | $ 3.18 | I | By SPVC VI, LLC (4) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Split Rock Partners LLC 10400 VIKING DR SUITE 550 MINNEAPOLIS, MN 55344 |
 |  X |  |  |
SPVC V, LLC 10400 VIKING DR STE 550 EDEN PRAIRIE, MN 55344 |
 |  X |  |  |
SPVC VI, LLC 10400 VIKING DR STE 550 EDEN PRAIRIE, MN 55344 |
 |  X |  |  |
/s/ James R. Simons, Managing Director of Split Rock Partners, LLC | 08/07/2007 | |
**Signature of Reporting Person | Date | |
/s/ James R. Simons, Managing Member of SPVC V, LLC | 08/07/2007 | |
**Signature of Reporting Person | Date | |
/s/ James R. Simons, Managing Director of SPVC VI, LLC | 08/07/2007 | |
**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) | Each share of Series C and Series E Convertible Preferred Stock is convertible at any time at the option of the holder and will convert into shares of the Issuer's Common Stock in connection with the closing of the Issuer's initial public offering. |
(2) | Not applicable. |
(3) | Represents securities held directly by SPVC V, LLC, which is jointly managed by Split Rock Partners, LLC and Vesbridge Partners, LLC. Voting and investment power over the shares, however, has been delegated solely to Split Rock Partners, LLC. Split Rock Partners, LLC has delegated voting and investment decisions with respect to the shares to four individuals who require a two-thirds vote to act. Split Rock Partners, LLC may be deemed to be an indirect beneficial owner of the reported securities. Split Rock Partners, LLC disclaims any beneficial ownership of the reported securities, except to the extent of any pecuniary interest therein. This report shall not be deemed an admission that any of the reporting persons is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. |
(4) | Represents securities held directly by SPVC VI, LLC, which is jointly managed by Split Rock Partners, LLC and Vesbridge Partners, LLC. Voting and investment power over the shares, however, has been delegated solely to Split Rock Partners, LLC. Split Rock Partners, LLC has delegated voting and investment decisions with respect to the shares to four individuals who require a two-thirds vote to act. Split Rock Partners, LLC may be deemed to be an indirect beneficial owner of the reported securities. Split Rock Partners, LLC disclaims any beneficial ownership of the reported securities, except to the extent of any pecuniary interest therein. This report shall not be deemed an admission that any of the reporting persons is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. |