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 B Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
1,342,657
|
$
(1)
|
I
|
By H.I.G. Venture Partners II, L.P.
(2)
|
Series B Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
335,664
|
$
(1)
|
I
|
By H.I.G. Ventures - Alder, LLC
(2)
|
Series C Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
404,040
|
$
(1)
|
I
|
By H.I.G. Venture Partners II, L.P.
(2)
|
Series C Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
101,010
|
$
(1)
|
I
|
By H.I.G. Ventures - Adler, LLC
(2)
|
Series D Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
318,884
|
$
(1)
|
I
|
By H.I.G. Venture Partners II, L.P.
(2)
|
Series D Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
79,721
|
$
(1)
|
I
|
By H.I.G. Ventures - Alder, LLC
(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) |
Mr. Davidson is managing director of H.I.G. BioVentures, an affiliate of H.I.G. Ventures Partners II, L.P. and H.I.G. Ventures - Alder, LLC. As a managing director of an affiliate of the H.I.G. Funds, Mr. Davidson shares voting and investment power over the shares held by the H.I.G. Funds and may be deemed to have indirect beneficial ownership of such shares. Mr. Davidson disclaims beneficial ownership of the shares held by the H.I.G. Funds except to the extent of any pecuniary interest therein. |