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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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Mehra Anand C/O SOFINNOVA VENTURES 3000 SAND HILL ROAD, 4-250 MENLO PARK, CA 94025 |
X | |||
SOFINNOVA VENTURE PARTNERS VI L P C/O SOFINNOVA VENTURES 3000 SAND HILL ROAD, 4-250 MENLO PARK, CA 94025 |
X | |||
Sofinnova Venture Partners VI GmbH & Co. KG C/O SOFINNOVA VENTURES 3000 SAND HILL ROAD, 4-250 MENLO PARK, CA 94025 |
X | |||
Sofinnova Venture Affiliates VI LP C/O SOFINNOVA VENTURES 3000 SAND HILL ROAD, 4-250 MENLO PARK, CA 94025 |
X | |||
Sofinnova Management VI, L.L.C. C/O SOFINNOVA VENTURES 3000 SAND HILL ROAD, 4-250 MENLO PARK, CA 94025 |
X | |||
Buatois Eric C/O SOFINNOVA VENTURES 3000 SAND HILL ROAD, 4-250 MENLO PARK, CA 94025 |
X | |||
HEALY JAMES C/O SOFINNOVA VENTURES 3000 SAND HILL ROAD, 4-250 MENLO PARK, CA 94025 |
X | |||
Azan Alain C/O SOFINNOVA VENTURES 3000 SAND HILL ROAD, 4-250 MENLO PARK, CA 94025 |
X | |||
POWELL MICHAEL C/O SOFINNOVA VENTURES 3000 SAND HILL ROAD, 4-250 MENLO PARK, CA 94025 |
X |
/s/ Nathalie Auber, attorney-in-fact for Anand Mehra | 10/24/2016 | |
**Signature of Reporting Person | Date | |
/s/ Nathalie Auber, Attorney-in-Fact for Sofinnova Venture Partners VI, L.P. | 10/24/2016 | |
**Signature of Reporting Person | Date | |
/s/ Nathalie Auber, Attorney-in-Fact for Sofinnova Venture Partners VI GmbH & Co. KG | 10/24/2016 | |
**Signature of Reporting Person | Date | |
/s/ Nathalie Auber, Attorney-in-Fact for Sofinnova Venture Affiliates VI, L.P. | 10/24/2016 | |
**Signature of Reporting Person | Date | |
/s/ Nathalie Auber, Attorney-in-Fact for Sofinnova Management VI, L.L.C. | 10/24/2016 | |
**Signature of Reporting Person | Date | |
/s/ Nathalie Auber, Attorney-in-Fact for Alain Azan | 10/24/2016 | |
**Signature of Reporting Person | Date | |
/s/ Nathalie Auber, Attorney-in-Fact for Eric Buatois | 10/24/2016 | |
**Signature of Reporting Person | Date | |
/s/ Nathalie Auber, Attorney-in-Fact for James Healy | 10/24/2016 | |
**Signature of Reporting Person | Date | |
/s/ Nathalie Auber, Attorney-in-Fact for Michael Powell | 10/24/2016 | |
**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) | Shares are held by Sofinnova Venture Partners VI, L.P. ("SVP VI"). Sofinnova Management VI, L.L.C. ("SM VI") is the general partner of SVP VI and James I. Healy ("Healy"), Michael F. Powell ("Powell"), Alain L. Azan ("Azan") and Eric P. Buatois ("Buatois"), the managing members of SM VI, and Anand Mehra ("Mehra"), a former director of the Issuer, may be deemed to share voting and dispositive power over the shares held by such entities. |
(2) | Shares are held by Sofinnova Venture Partners VI GmbH & Co. KG ("SVP KG"). SM VI is the managing limited partner of SVP KG, and Healy, Powell, Azan and Buatois, the managing members of SM VI, and Mehra, a former director of the Issuer, may be deemed to share voting and dispositive power over the shares held by such entities. |
(3) | Shares are held by Sofinnova Venture Affiliates VI, L.P. ("SVA VI"). SM VI is the general partner of SVA VI, and Healy, Powell, Azan and Buatois, the managing members of SM VI, and Mehra, a former director of the Issuer, may be deemed to share voting and dispositive power over the shares held by such entities. |