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 B Convertible Preferred Stock | Â (1) | Â (1) | Common Stock | 1,821,084 (1) | $ 0 | D (2) | Â |
Series C Convertible Preferred Stock | Â (3) | Â (3) | Common Stock | 733,880 (3) | $ 0 | D (2) | Â |
Series D1 Convertible Preferred Stock | Â (4) | Â (4) | Common Stock | 265,219 (4) | $ 0 | D (2) | Â |
Series D2 Convertible Preferred Stock | Â (5) | Â (5) | Common Stock | 117,342 (5) | $ 0 | D (2) | Â |
Series E Convertible Preferred Stock | Â (6) | Â (6) | Common Stock | 308,356 (6) | $ 0 | D (2) | Â |
Warrant | Â (7) | Â (8) | Series B Convertible Preferred Stock | 759,565 (9) | $ 0.45 | D (2) | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
New Leaf Ventures II, L.P. C/O NEW LEAF VENTURES TIMES SQ. TOWER, 7 TIMES SQ., STE. 3502 NEW YORK, NY 10036 |
 X |  X |  |  |
New Leaf Venture Associates II, L.P. C/O NEW LEAF VENTURES TIMES SQ. TOWER, 7 TIMES SQ., STE. 3502 NEW YORK, NY 10036 |
 X |  X |  |  |
New Leaf Venture Management II, L.L.C. C/O NEW LEAF VENTURES TIMES SQ. TOWER, 7 TIMES SQ., STE. 3502 NEW YORK, NY 10036 |
 X |  X |  |  |
Chambon Philippe O. C/O NEW LEAF VENTURES TIMES SQ. TOWER, 7 TIMES SQ., STE. 3502 NEW YORK, NY 10036 |
 |  X |  |  |
NIEDEL JAMES C/O NEW LEAF VENTURES TIMES SQ. TOWER, 7 TIMES SQ., STE. 3502 NEW YORK, NY 10036 |
 |  X |  |  |
HUNT RONALD C/O NEW LEAF VENTURES TIMES SQ. TOWER, 7 TIMES SQ., STE. 3502 NEW YORK, NY 10036 |
 |  X |  |  |
Lathi Vijay K C/O NEW LEAF VENTURES 2500 SAND HILL ROAD, SUITE 203 MENLO PARK, CA 94025 |
 |  X |  |  |
Delagardelle Jeani C/O NEW LEAF VENTURES 2500 SAND HILL ROAD, SUITE 203 MENLO PARK, CA 94025 |
 |  X |  |  |
Ratcliffe Liam C/O NEW LEAF VENTURES TIMES SQ. TOWER, 7 TIMES SQ., STE. 3502 NEW YORK, NY 10036 |
 |  X |  |  |
/s/ Craig L. Slutzkin, Chief Financial Officer of New Leaf Venture Management II, L.L.C., the sole general partner of New Leaf Venture Associates II, L.P., the sole general partner of New Leaf Ventures II, L.P. | 03/20/2014 | |
**Signature of Reporting Person | Date | |
/s/ Craig L. Slutzkin, Chief Financial Officer of New Leaf Venture Management II, L.L.C., the sole general partner of New Leaf Venture Associates II, L.P. | 03/20/2014 | |
**Signature of Reporting Person | Date | |
/s/ Craig L. Slutzkin, Chief Financial Officer of New Leaf Venture Management II, L.L.C. | 03/20/2014 | |
**Signature of Reporting Person | Date | |
/s/ Craig L. Slutzkin, as Attorney-in-Fact for Philippe O. Chambon | 03/20/2014 | |
**Signature of Reporting Person | Date | |
/s/ Craig L. Slutzkin, as Attorney-in-Fact for James Niedel | 03/20/2014 | |
**Signature of Reporting Person | Date | |
/s/ Craig L. Slutzkin, as Attorney-in-Fact for Ronald Hunt | 03/20/2014 | |
**Signature of Reporting Person | Date | |
/s/ Craig L. Slutzkin, as Attorney-in-Fact for Vijay Lathi | 03/20/2014 | |
**Signature of Reporting Person | Date | |
/s/ Craig L. Slutzkin, as Attorney-in-Fact for Jeani Delagardelle | 03/20/2014 | |
**Signature of Reporting Person | Date | |
/s/ Craig L. Slutzkin, as Attorney-in-Fact for Liam Ratcliffe | 03/20/2014 | |
**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) | The Series B Convertible Preferred Stock has no expiration date and will automatically convert upon the completion of the issuer's initial public offering of Common Stock on a 1-for-11.5 basis, for no additional consideration. |
(2) | Represents shares directly beneficially owned by New Leaf Ventures II, L.P. ("NLV II"). New Leaf Venture Associates II, L.P. ("NLV Associates II") is the general partner of NLV II and New Leaf Venture Management II, L.L.C. ("NLV Management II") is the general partner of NLV Associates II. Philippe O. Chambon, Jeani Delagardelle, Ronald Hunt, Vijay Lathi, James Niedel and Liam Ratcliffe are the individual managers of NLV Management II (the "Individual Managers"). NLV Associates II and NLV Management II disclaim beneficial ownership of such shares, except to the extent of their pecuniary interest therein. As one of six individual managers, each of the Individual Managers disclaims beneficial ownership over the shares reported herein, and in all events disclaims pecuniary interest except to the extent of his economic interest. |
(3) | The Series C Convertible Preferred Stock has no expiration date and will automatically convert upon the completion of the issuer's initial public offering of Common Stock on a 1-for-11.5 basis, for no additional consideration. |
(4) | The Series D1 Convertible Preferred Stock has no expiration date and will automatically convert upon the completion of the issuer's initial public offering of Common Stock on a 1-for-11.5 basis, for no additional consideration. |
(5) | The Series D2 Convertible Preferred Stock has no expiration date and will automatically convert upon the completion of the issuer's initial public offering of Common Stock on a 1-for-11.5 basis, for no additional consideration. |
(6) | The Series E Convertible Preferred Stock has no expiration date and will automatically convert upon the completion of the issuer's initial public offering of Common Stock on a 1-for-11.5 basis, for no additional consideration. |
(7) | The Warrant is immediately exerciseable. |
(8) | The Warrant shall expire on the earlier of October 12, 2017 or the closing of the Issuer's initial public offering. |
(9) | Unless exercised earlier, the Warrant to purchase shares of Series B Convertible Preferred Stock will automatically convert upon the completion of the issuer's initial public offering of Common Stock into a warrant to purchase Common Stock on a 1-for-11.5 basis. |