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 C Preferred Stock
|
Â
(1)
|
Â
(2)
|
Common Stock
|
223,684
|
$
0
|
I
|
Directly owned by HLM Venture Partners II, L.P.
(3)
|
Series D Preferred Stock
|
Â
(1)
|
Â
(2)
|
Common Stock
|
1,230,374
|
$
0
|
I
|
Directly owned by HLM Venture Partners II, L.P.
(3)
|
Preferred Stock Warrant
|
Â
(4)
|
08/17/2021 |
Series D Preferred Stock
(5)
|
87,662
(5)
|
$
4.4
(5)
|
I
|
Directly owned by HLM Venture Partners II, L.P.
(3)
|
Preferred Stock Warrant
|
Â
(4)
|
05/25/2022 |
Series D Preferred Stock
(6)
|
21,915
(6)
|
$
4.4
(6)
|
I
|
Directly owned by HLM Venture Partners II, L.P.
(3)
|
Preferred Stock Warrant
|
Â
(4)
|
07/17/2022 |
Series D Preferred Stock
(7)
|
33,014
(7)
|
$
4.4
(7)
|
I
|
Directly owned by HLM Venture Partners II, L.P.
(3)
|
* |
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 securities are immediately convertible. |
(2) |
The expiration date is not relevant to the conversion of these securities. |
(3) |
The Reporting Person is a managing member of HLM Venture Associates II, L.L.C. ("Associates"), the general partner of HLM Venture Partners II, L.P. ("Partners"). As a managing member of Associates, the Reporting Person shares voting and investment power over the securities held by Partners and may be deemed to have indirect beneficial ownership of such shares. The Reporting Person disclaims beneficial ownership of such securities held by Partners, except to the extent of his proportionate pecuniary interest therein. |
(4) |
The warrants are immediately exercisable. |
(5) |
Upon the consummation of the Issuer's initial public offering, these warrants will automatically become exercisable for 52,316 shares of the Issuer's common stock at an exercise price of $4.40 per share. |
(6) |
Upon the consummation of the Issuer's initial public offering, these warrants will automatically become exercisable for 13,078 shares of the Issuer's common stock at an exercise price of $4.40 per share. |
(7) |
Upon the consummation of the Issuer's initial public offering, these warrants will automatically become exercisable for 19,702 shares of the Issuer's common stock at an exercise price of $4.40 per share. |