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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 |
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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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series A Preferred Stock (1) | (1) | 07/23/2013 | C | 100,000 | (4) | (5) | Common Stock | 100,000 | (1) | 0 | I | Directly owned by LVP I (2) (3) | |||
Series A Preferred Stock (1) | (1) | 07/23/2013 | C | 426,315 | (4) | (5) | Common Stock | 426,315 | (1) | 0 | I | Directly owned by LVP II (2) (3) | |||
Series B Preferred Stock (1) | (1) | 07/23/2013 | C | 65,476 | (4) | (5) | Common Stock | 65,476 | (1) | 0 | I | Directly owned by LVP I (2) (3) | |||
Series B Preferred Stock (1) | (1) | 07/23/2013 | C | 279,135 | (4) | (5) | Common Stock | 279,135 | (1) | 0 | I | Directly owned by LVP II (2) (3) | |||
Series B Preferred Stock (1) | (1) | 07/23/2013 | C | 611,995 | (4) | (5) | Common Stock | 611,995 | (1) | 0 | I | Directly owned by LVP III (2) (3) | |||
Series B Preferred Stock (1) | (1) | 07/23/2013 | C | 30,599 | (4) | (5) | Common Stock | 30,599 | (1) | 0 | I | Directly owned by Associates (2) (3) | |||
Series B Preferred Stock (1) | (1) | 07/23/2013 | C | 15,299 | (4) | (5) | Common Stock | 15,299 | (1) | 0 | I | Directly owned by Partners (2) (3) | |||
Series B-1 Preferred Stock (1) | (1) | 07/23/2013 | C | 74,142 | (4) | (5) | Common Stock | 74,142 | (1) | 0 | I | Directly owned by LVP I (2) (3) | |||
Series B-1 Preferred Stock (1) | (1) | 07/23/2013 | C | 316,079 | (4) | (5) | Common Stock | 316,079 | (1) | 0 | I | Directly owned by LVP II (2) (3) | |||
Series B-1 Preferred Stock (1) | (1) | 07/23/2013 | C | 692,994 | (4) | (5) | Common Stock | 692,994 | (1) | 0 | I | Directly owned by LVP III (2) (3) | |||
Series B-1 Preferred Stock (1) | (1) | 07/23/2013 | C | 34,649 | (4) | (5) | Common Stock | 34,649 | (1) | 0 | I | Directly owned by Associates (2) (3) | |||
Series B-1 Preferred Stock (1) | (1) | 07/23/2013 | C | 17,324 | (4) | (5) | Common Stock | 17,324 | (1) | 0 | I | Directly owned by Partners (2) (3) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
LVP GP I, LLC ONE EMBARCADERO CENTER SUITE 4050 SAN FRANCISCO, CA 94111 |
X | |||
LVP GP II, LLC ONE EMBARCADERO CENTER SUITE 4050 SAN FRANCISCO, CA 94111 |
X | |||
LVP GP III, LLC ONE EMBARCADERO CENTER SUITE 4050 SAN FRANCISCO, CA 94111 |
X | |||
LVP Life Science Ventures I, L.P. ONE EMBARCADERO CENTER SUITE 4050 SAN FRANCISCO, CA 94111 |
X | |||
LVP Life Science Ventures II, L.P. ONE EMBARCADERO CENTER SUITE 4050 SAN FRANCISCO, CA 94111 |
X | |||
LVP LIFE SCIENCE VENTURES III L.P. ONE EMBARCADERO CENTER SUITE 4050 SAN FRANCISCO, CA 94111 |
X | |||
LVP III Associates, L.P. ONE EMBARCADERO CENTER SUITE 4050 SAN FRANCISCO, CA 94111 |
X | |||
LVP III Partners LP ONE EMBARCADERO CENTER SUITE 4050 SAN FRANCISCO, CA 94111 |
X | |||
LVPMC, LLC ONE EMBARCADERO CENTER SUITE 4050 SAN FRANCISCO, CA 94111 |
X | |||
LATTERELL PATRICK F ONE EMBARCADERO CENTER SUITE 4050 SAN FRANCISCO, CA 94111 |
X |
/s/ Patrick Latterell, Managing Member of LVP GP I, LLC | 07/23/2013 | |
**Signature of Reporting Person | Date | |
/s/ Patrick Latterell, Managing Member of LVP GP II, LLC | 07/23/2013 | |
**Signature of Reporting Person | Date | |
/s/ Patrick Latterell, Managing Member of LVP GP III, LLC | 07/23/2013 | |
**Signature of Reporting Person | Date | |
/s/ Patrick Latterell, Managing Member of LVPMC, LLC | 07/23/2013 | |
**Signature of Reporting Person | Date | |
/s/ Patrick Latterell, Managing Member of LVP GP I, LLC, General Partner of LVP Life Science Ventures I, L.P. | 07/23/2013 | |
**Signature of Reporting Person | Date | |
/s/ Patrick Latterell, Managing Member of LVP GP II, LLC, General Partner of LVP Life Science Ventures II, L.P. | 07/23/2013 | |
**Signature of Reporting Person | Date | |
/s/ Patrick Latterell, Managing Member of LVP GP III, LLC, General Partner of LVP Life Science Ventures III, L.P. | 07/23/2013 | |
**Signature of Reporting Person | Date | |
/s/ Patrick Latterell, Managing Member of LVP GP III, LLC, General Partner of LVP III Associates, L.P. | 07/23/2013 | |
**Signature of Reporting Person | Date | |
/s/ Patrick Latterell, Managing Member of LVP GP III, LLC, General Partner of LVP III Partners, L.P. | 07/23/2013 | |
**Signature of Reporting Person | Date | |
/s/ Patrick Latterell | 07/23/2013 | |
**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 Series A, Series B and Series B-1 Preferred Stock automatically converted on a one-to-one basis into Common Stock immediately prior to the consummation of the Issuer's initial public offering on July 23, 2013. |
(2) | The reported securities are owned directly by each of LVPMC, LLC ("LVPMC"), LVP Life Science Ventures I, L.P. ("LVP I"), LVP Life Science Ventures II, L.P. ("LVP II"), LVP Life Science Ventures III, L.P ("LVP III"), LVP III Associates, L.P. ("Associates") and LVP III Partners, L.P. ("Partners"). LVP GP I, LLC ("GP I") is the general partner of LVP I, LVP GP II, LLC ("GP II") is the general partner of LVP II and LVP GP III, LLC ("GP III") is the general partner of LVP III, Associates and Partners. (Continued on Footnote 3) |
(3) | GP I, GP II and GP III may be deemed to have sole voting power and dispositive power over the shares held by LVP I, LVP II, LVP III, Associates and Partners. Each of GP I, GP II, GP III and Patrick Latterell, the managing member of each of GP I, GP II and GP III and the manager of LVPMC may be deemed to share voting and dispositive power over the reported securities and disclaim beneficial ownership of the reported securities held by LVPMC, LVP I, LVP II, LVP III, Associates and Partners except to the extent of any pecuniary interest therein. James W. Woody, M.D., Ph.D., as a member of each of GP I, GP II and GP III, may be deemed to share voting and dispositive power over the reported securities held by LVP I, LVP II, LVP III, Associates and Partners, and disclaims beneficial ownership of such securities except to the extent of any pecuniary interest therein. |
(4) | The securities are immediately convertible. |
(5) | The expiration date is not relevant to the conversion of these securities. |