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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series A-1 Convertible Preferred Stock | (1) | 11/29/2010 | C | 21,000,000 | (1) | (1) | Common Stock | 2,100,000 | (1) | 0 | D (2) (4) | ||||
Series B Convertible Preferred Stock | (1) | 11/29/2010 | C | 12,479,474 | (1) | (1) | Common Stock | 1,247,947 | (1) | 0 | D (2) (4) | ||||
8% Convertible Promissory Note | (3) | 11/29/2010 | C(3) | 884,492 | (3) | (3) | Common Stock | 884,492 | (3) | 0 | D (2) (4) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Clarus Lifesciences I, L.P. C/O CLARUS VENTURES, LLC 101 MAIN STREET, SUITE 1210 CAMBRIDGE, MA 92130 |
X | |||
Clarus Ventures I, LLC C/O CLARUS VENTURES , LLC 101 MAIN STREET, SUITE 1210 CAMBRIDGE, MA 02142 |
X | |||
Clarus Ventures I Management, L.P. C/O CLARUS VENTURES , LLC 101 MAIN STREET, SUITE 1210 CAMBRIDGE, MA 02142 |
X | |||
LIPTAK ROBERT C/O CLARUS VENTURES , LLC 101 MAIN STREET, SUITE 1210 CAMBRIDGE, MA 02142 |
X | |||
Simon Nicholas C/O CLARUS VENTURES , LLC 101 MAIN STREET, SUITE 1210 CAMBRIDGE, MA 02142 |
X | |||
HENNER DENNIS C/O CLARUS VENTURES , LLC 101 MAIN STREET, SUITE 1210 CAMBRIDGE, MA 02142 |
X | |||
GALAKATOS NICHOLAS C/O CLARUS VENTURES , LLC 101 MAIN STREET, SUITE 1210 CAMBRIDGE, MA 02142 |
X | |||
STEINMETZ MICHAEL C/O CLARUS VENTURES , LLC 101 MAIN STREET, SUITE 1210 CAMBRIDGE, MA 02142 |
X |
/s/ Robert Liptak, Managing Member of Clarus Ventures I, LLC, the general partner of Clarus Ventures I Management, L.P., which is the general partner of Clarus Lifesciences I, L.P. | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ Robert Liptak, Managing Member of Clarus Ventures I, LLC | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ Robert Liptak, Managing Member of Clarus Ventures I, LLC, the general partner of Clarus Ventures I Management, L.P. | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ Robert Liptak | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ Robert Liptak, as Attorney-in-fact for Nicholas Simon | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ Robert Liptak, as Attorney-in-fact for Dennis Henner | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ Robert Liptak, as Attorney-in-fact for Nicholas Galakatos | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ Robert Liptak, as Attorney-in-fact for Michael Steinmetz | 11/29/2010 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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) | Each of the Series A-1 Convertible Preferred Stock and the Series B Convertible Preferred Stock automatically converted to Common Stock upon the closing of the Issuer's initial public offering on November 29, 2010 at a conversion ratio of one share of Common Stock for every ten shares of Series A-1 Convertible Preferred Stock and one share of Common Stock for every ten shares of Series B Convertible Preferred Stock, as applicable, rounded down to the next whole number, for no additional consideration. |
(2) | These securities are held of record by Clarus Lifesciences I, L.P. ("CLI"). Clarus Ventures I Management, L.P. ("CVIM LP") is the general partner of CLI, and Clarus Ventures I, LLC ("CVI LLC") is the general partner of CVIM LP. As such, CVI LLC and CVIM LP may each be deemed to share voting and dispositive power with respect to the securities owned by CLI, but each disclaims beneficial ownership of such securities except to the extent of its pecuniary interest therein. Each of Messrs. Galakatos, Henner, Liptak, Simon and Steinmetz is a manager of CVI LLC and a general partner of CVIM LP and in such capacities may be deemed to beneficially own the securities held of record by CVI, but each disclaims beneficial ownership of such securities except to the extent of his pecuniary interest therein. |
(3) | The principle of the Note and accrued interest thereon was automatically converted upon the closing of the Issuer's initial public offering on November 29, 2010 into shares of Common Stock at a conversion price equal to $4.00 per share, the per share price of the Common Stock sold in the Issuer's initial public offering. |
(4) | The filing of this statement shall not be deemed an admission that, for the purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, the Reporting Persons are the beneficial owners of equity securities covered by this statement. |