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 |
Common Stock Warrant (right to buy)
|
12/07/2011 |
12/06/2016 |
Common Stock
|
14,005
|
$
0.2
|
D
|
|
Common Stock Warrant (right to buy)
|
05/15/2012 |
05/14/2017 |
Common Stock
|
14,005
|
$
0.2
|
D
|
|
Common Stock Warrant (right to buy)
|
12/11/2013 |
12/10/2018 |
Common Stock
|
43,704
|
$
0.2
|
D
|
|
Series B Preferred Stock
|
08/25/2000 |
(1)
|
Common Stock
|
30,930
(1)
|
$
(1)
|
D
|
|
Series C Preferred Stock
|
06/19/2002 |
(2)
|
Common Stock
|
96,294
(2)
|
$
(2)
|
D
|
|
Series D-1 Preferred Stock
|
12/11/2013 |
(3)
|
Common Stock
|
39,685
(3)
|
$
(3)
|
D
|
|
Series D-2 Preferred Stock
|
12/11/2013 |
(4)
|
Common Stock
|
147,588
(4)
|
$
(4)
|
D
|
|
* |
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) |
Each of the Series B Preferred Stock is convertible into Common Stock of the Issuer on a 1-for-3.536 basis at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. |
(2) |
Each of the Series C Preferred Stock is convertible into Common Stock of the Issuer on a 1-for-3.536 basis at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. |
(3) |
Each of the Series D-1 Preferred Stock is convertible into Common Stock of the Issuer on a 1-for-20.4 basis at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. |
(4) |
Each of the Series D-2 Preferred Stock is convertible into Common Stock of the Issuer on a 1-for-20.4 basis at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. |