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-1 Convertible Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
35,671
|
$
(1)
|
D
|
Â
|
Series A-2 Convertible Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
35,671
|
$
(1)
|
D
|
Â
|
Series B Convertible Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
77,211
|
$
(1)
|
D
|
Â
|
Convertible Promissory Notes
|
Â
(2)
|
Â
(2)
|
Common Stock
|
(2)
|
$
(2)
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(3)
|
08/26/2019 |
Common Stock
|
25,862
|
$
0.29
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(4)
|
12/02/2020 |
Common Stock
|
6,896
|
$
3.08
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(5)
|
08/24/2021 |
Common Stock
|
12,413
|
$
11.02
|
D
|
Â
|
* |
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 reported securities are convertible at any time, in whole or in part, at the option of the reporting person, have no expiration date, and will automatically convert into shares of Common Stock immediately prior to the closing of the Issuer's initial public offering. |
(2) |
The outstanding $410,000 principal amount of these 5% convertible promissory notes and all accrued and unpaid interest thereon from and after May 25, 2011 will automatically convert into shares of Common Stock immediately prior to the closing of the Issuer's initial public offering at a conversion price equal to the per share price to the public of the Common Stock sold in the Issuer's initial public offering. |
(3) |
The option is immediately exercisable as to both vested and unvested shares. 25% of the shares subject to the option vested on each of August 26, 2009, August 26, 2010 and August 26, 2011, and 25% of the shares subject to the option shall vest on August 26, 2012. To the extent the reporting person exercises the option as to unvested shares, the reporting person will receive restricted shares that will vest in accordance with the vesting schedule for the option. |
(4) |
The option is immediately exercisable as to both vested and unvested shares. 25% of the shares subject to the option vested on each of December 2, 2010 and August 26, 2011, and 25% of the shares subject to the option shall vest on each of August 26, 2012 and August 26, 2013. To the extent the reporting person exercises the option as to unvested shares, the reporting person will receive restricted shares that will vest in accordance with the vesting schedule for the option. |
(5) |
The option is immediately exercisable as to both vested and unvested shares. The option shall vest on August 24, 2012. To the extent the reporting person exercises the option as to unvested shares, the reporting person will receive restricted shares that will vest in accordance with the vesting schedule for the option. |