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 A Preferred Stock | Â (1) | Â (1) | Common Stock | 967,741 (1) | $ (1) | I | Direct and Indirect -See footnotes (2) (3) |
Series B Preferred Stock | Â (1) | Â (1) | Common Stock | 1,354,838 (1) | $ (1) | I | Direct and Indirect - See footnotes (2) (4) |
Series B-1 Preferred Stock | Â (1) | Â (1) | Common Stock | 314,516 (1) | $ (1) | I | Direct and Indirect - See footnotes (2) (5) |
Series C Preferred Stock | Â (1) | Â (1) | Common Stock | 780,755 (1) | $ (1) | I | Direct and Indirect - See footnotes (2) (6) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Alta Partners VIII, L.P. C/O ALTA PARTNERS, ONE EMBARCADERO CENTER, 37TH FLOOR SAN FRANCISCO, CA 94111 |
 |  X |  |  |
Alta Partners Management VIII, LLC C/O ALTA PARTNERS, ONE EMBARCADERO CENTER, 37TH FLOOR SAN FRANCISCO, CA 94111 |
 |  X |  |  |
CHAMPSI FARAH C/O ALTA PARTNERS, ONE EMBARCADERO CENTER, 37TH FLOOR SAN FRANCISCO, CA 94111 |
 X |  X |  |  |
NOHRA GUY P C/O ALTA PARTNERS, ONE EMBARCADERO CENTER, 37TH FLOOR SAN FRANCISCO, CA 94111 |
 |  X |  |  |
JANNEY DANIEL C/O ALTA PARTNERS, ONE EMBARCADERO CENTER, 37TH FLOOR SAN FRANCISCO, CA 94111 |
 |  X |  |  |
/s/Derek Colla, Attorney-in-Fact | 01/30/2014 | |
**Signature of Reporting Person | Date | |
Derek Colla, Attorney-in-Fact | 01/30/2014 | |
**Signature of Reporting Person | Date | |
Derek Colla, Attorney-in-Fact | 01/30/2014 | |
**Signature of Reporting Person | Date | |
Derek Colla, Attorney-in-Fact | 01/30/2014 | |
**Signature of Reporting Person | Date | |
Derek Colla, Attorney-in-Fact | 01/30/2014 | |
**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) | Immediately prior to closing of the issuer's initial public offering, the preferred stock held by the reporting persons will automatically convert into common stock on a 6.2 to 1 basis. |
(2) | The securities are held of record by Alta Partners VIII, L.P. ("APVIII"). Alta Partners Management VIII, LLC ("APMVIII") is the general partner of APVIII. Guy Nohra, Daniel Janney and Farah Champsi are managing directors of APMVIII and exercise shared voting and investment power with respect to the shares onwed by APVIII. Each of the reporting persons disclaims beneficial ownership of such securities, except to the extent of his, her or its proportionate pecuniary interest therein. Ms. Champsi is also a director of the issuer. |
(3) | APVIII holds an aggregate of 6,000,000 shares of Series A Preferred Stock which is convertible into 967,741 shares of Common Stock. |
(4) | APVIII holds an aggregate of 8,400,000 shares of Series B Preferred Stock which is convertible into 1,354,838 shares of Common Stock. |
(5) | APVIII holds an aggregate of 1,950,000 shares of Series B-1 Preferred Stock which is convertible into 314,516 shares of Common Stock. |
(6) | APVIII holds an aggregate of 4,840,686 shares of Series C Preferred Stock which is convertible into 780,755 shares of Common Stock. |