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 A Convertible Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
660,849
|
$
(1)
|
I
|
By Prospect Venture Partners II, L.P.
(2)
|
Series A Convertible Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
10,063
|
$
(1)
|
I
|
By Prospect Associates II, L.P.
(3)
|
Series B Convertible Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
554,801
|
$
(1)
|
I
|
By Prospect Venture Partners II, L.P.
(4)
|
Series B Convertible Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
8,448
|
$
(1)
|
I
|
By Prospect Associates II, L.P.
(5)
|
* |
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 Issuer's Preferred Stock will automatically convert into Common Stock on a one-for-one basis upon the closing of the Issuer's initial public offering of common stock pursuant to an effective registration statement filed with the United States Securities and Exchange Commission. These shares have no expiration date. |
(2) |
The shares are owned by Prospect Venture Partners II, L.P. ("PVP II"). Prospect Management Co. II, L.L.C. ("PMC II") serves as the general partner of PVP II. James B. Tananbaum, M.D. is Managing Director of PMC II and shares voting and investment power over the shares held by PVP II. The reporting person disclaims beneficial ownership of the shares reported herein, except to the extent of his pecuniary interest. |
(3) |
The shares are owned by Prospect Associates II, L.P. ("PA II"). PMC II serves as the general partner of PA II. James B. Tananbaum, M.D. is Managing Director of PMC II and shares voting and investment power over the shares held by PA II. The reporting person disclaims beneficial ownership of the shares reported herein, except to the extent of his pecuniary interest. |
(4) |
The shares are owned by PVP II. |
(5) |
The shares are owned by PA II. |