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 Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
6,808
|
$
(1)
|
I
|
Delphi Ventures VIII, L.P.
(2)
|
Series A Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
66
|
$
(1)
|
I
|
Delphi BioInvestments VIII, L.P.
(2)
|
Series B Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
415,128
|
$
(1)
|
I
|
Delphi Ventures VIII, L.P.
(2)
|
Series B Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
4,053
|
$
(1)
|
I
|
Delphi BioInvestments VIII, L.P.
(2)
|
Series C Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
740,312
|
$
(1)
|
I
|
Delphi Ventures VIII, L.P.
(2)
|
Series C Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
7,228
|
$
(1)
|
I
|
Delphi BioInvestments VIII, L.P.
(2)
|
Series D Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
745,825
|
$
(1)
|
I
|
Delphi Ventures VIII, L.P.
(2)
|
Series D Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
7,282
|
$
(1)
|
I
|
Delphi BioInvestments VIII, L.P.
(2)
|
* |
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 preferred stock is convertible at any time, at the holder's election, and has no expiration date. The preferred stock will automatically convert into common stock on a 1-to-1 basis upon closing of the initial public offering of the issuer. |
(2) |
The securities are directly held as follows: 1,908,073 shares by Delphi Ventures VIII, L.P. ("DV VIII") and 18,629 shares held by Delphi BioInvestments VIII, L.P. ("DBI VIII" and together with DV VIII, the "Delphi VIII Funds"). Delphi Management Partners VIII, L.L.C. ("DMP VIII") is the general partner of each of DV VIII and DBI VIII and may be deemed to have sole voting and dispositive power over the securities held by the Delphi VIII Funds. The Reporting Person is a managing member of DMP VIII and may be deemed to share voting and dispositive power over the securities held by the Delphi VIII Funds. The Reporting Person disclaims beneficial ownership of the securities held by Delphi VIII Funds, except to the extent of any pecuniary interest therein. |