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 | 6,808 | $ (1) | I | Delphi Ventures VIII, L.P. (2) |
Series A Preferred Stock | Â (1) | Â (1) | Common Stock | 66 | $ (1) | I | Delphi BioInvestments VIII, L.P. (3) |
Series B Preferred Stock | Â (1) | Â (1) | Common Stock | 415,128 | $ (1) | I | Delphi Ventures VIII, L.P. (2) |
Series B Preferred Stock | Â (1) | Â (1) | Common Stock | 4,053 | $ (1) | I | Delphi BioInvestments VIII, L.P. (3) |
Series C Preferred Stock | Â (1) | Â (1) | Common Stock | 740,312 | $ (1) | I | Delphi Ventures VIII, L.P. (2) |
Series C Preferred Stock | Â (1) | Â (1) | Common Stock | 7,228 | $ (1) | I | Delphi BioInvestments VIII, L.P. (3) |
Series D Preferred Stock | Â (1) | Â (1) | Common Stock | 745,825 | $ (1) | I | Delphi Ventures VIII, L.P. (2) |
Series D Preferred Stock | Â (1) | Â (1) | Common Stock | 7,282 | $ (1) | I | Delphi BioInvestments VIII, L.P. (3) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Delphi Management Partners VIII, L.L.C. C/O DELPHI VENTURES, 3000 SAND HILL ROAD, BLDG. 1, SUITE 135 MENLO PARK, CA 94025 |
 |  X |  |  |
DELPHI VENTURES VIII LP 3000 SAND HILL RD. BLDG 1, SUITE 135 MENLO PARK, CA 94025 |
 |  X |  |  |
Delphi BioInvestments VIII LP 3000 SAND HILL RD. BLDG 1, SUITE 135 MENLO PARK, CA 94025 |
 |  X |  |  |
ROEDER DOUGLAS A C/O DELPHI VENTURES 3000 SAND HILL RD., BLDG 1, SUITE 135 MENLO PARK, CA 94025 |
 |  X |  |  |
DOUGLASS DAVID L C/O DELPHI VENTURES 3000 SAND HILL RD., BLDG 1, SUITE 135 MENLO PARK, CA 94025 |
 |  X |  |  |
BOCHNOWSKI JAMES J C/O DELPHI VENTURES 3000 SAND HILL RD., BLDG 1, SUITE 135 MENLO PARK, CA 94025 |
 |  X |  |  |
PAKIANATHAN DEEPIKA C/O DELPHI VENTURES 3000 SAND HILL ROAD, BLDG. 1, SUITE 135 MENLO PARK, CA 94025 |
 X |  X |  |  |
By:/s/ Matthew T. Potter, Name: Matthew T. Potter,Attorney-in-Fact for:Delphi Management Partners VIII, L.L.C.,Delphi Ventures VIII, L.P., Delphi BioInvestments VIII, L.P., Deepika R. Pakianathan, Douglas A. Roder, David L. Douglass and James J.Bochnowski | 10/01/2014 | |
**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) | 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) | The reported securities are directly owned by Delphi Ventures VIII, L.P. ("DV VIII"). Delphi Management Partners VIII, L.L.C. ("DMP VIII") is the general partner of DV VIII and may be deemed to have sole voting and dispositive power over the securities held by DV VIII. Douglas A. Roeder, James J. Bochnowski, David L. Douglass and Deepika R. Pakianathan, Ph.D. are the managing members of DMP VIII and may be deemed to share voting and dispositive power over the securities held by DV VIII. Such persons and entities disclaim beneficial ownership of the securities held by DV VIII, except to the extent of any pecuniary interest therein. |
(3) | The reported securities are directly owned by Delphi BioInvestments VIII, L.P. ("DBI VIII"). DMP VIII is the general partner of DBI VIII and may be deemed to have sole voting and dispositive power over the securities held by DBI VIII. Douglas A. Roeder, James J. Bochnowski, David L. Douglass and Deepika R. Pakianathan, Ph.D. are the managing members of DMP VIII and may be deemed to share voting and dispositive power over the securities held by DBI VIII. Such persons and entities disclaim beneficial ownership of the securities held by DBI VIII, except to the extent of any pecuniary interest therein. |