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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 C Preferred Stock | (2) | 11/19/2013 | C | 1,113,545 (3) | (2) | (2) | Common Stock | 664,565 (2) | $ 0 | 0 | I | Directly owned by Delphi Ventures VIII, L.P. (1) | |||
Series C Preferred Stock | (2) | 11/19/2013 | C | 10,871 (3) | (2) | (2) | Common Stock | 6,488 (2) | $ 0 | 0 | I | Directly owned by Delphi BioInvestments VIII, L.P. (1) | |||
Series D Preferred Stock | (2) | 11/19/2013 | C | 4,973,160 | (2) | (2) | Common Stock | 2,967,987 (2) | $ 0 | 0 | I | Directly owned by Delphi Ventures VIII, L.P. (1) | |||
Series D Preferred Stock | (2) | 11/19/2013 | C | 48,558 | (2) | (2) | Common Stock | 28,979 (2) | $ 0 | 0 | I | Directly owned by Delphi BioInvestments VIII, L.P. (1) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
ROEDER DOUGLAS A C/O DELPHI VENTURES, 3000 SAND HILL RD., BLDG. 1, STE. 135 MENLO PARK, CA 94025 |
X | X |
/s/ Matthew T. Potter, by power of attorney for Douglas A. Roeder | 11/21/2013 | |
**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) | The Reporting Person is a managing member of Delphi Management Partners VIII, L.L.C. ("DMP"), the general partner of each of Delphi Ventures VIII, L.P. and Delphi BioInvestments VIII, L.P. (collectively, the "Delphi Funds"). As a managing member of DMP, the Reporting Person shares voting and investment power over the securities held by the Delphi Funds and may be deemed to have indirect beneficial ownership of such shares. The Reporting Person disclaims beneficial ownership of such securities held by the Delphi Funds, except to the extent of his proportionate pecuniary interest therein. |
(2) | Each share of Preferred Stock automatically converted on a 1-to-0.5968 basis into Common Stock immediately upon the consummation of the Issuer's initial public offering and had no expiration date. |
(3) | The number of shares of Preferred Stock reflects the effect of applicable anti-dilution adjustments that occurred as a result of the issuance of the Series D Preferred Stock. |