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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT 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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(Print or Type Responses)
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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) | ||
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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 AA Preferred Stock(1) | (1) | 05/15/2012 | C | 385,950 | (1) | (6) | Common Stock | 385,950 | (1) | 0 | I | See Footnote(2) | |||
| Series AA Preferred Stock(1) | (1) | 05/15/2012 | C | 159,893 | (1) | (6) | Common Stock | 159,893 | (1) | 0 | I | See Footnote(3) | |||
| Series AA Preferred Stock(1) | (1) | 05/15/2012 | C | 5,513 | (1) | (6) | Common Stock | 5,513 | (1) | 0 | I | See Footnote(4) | |||
| Series AA-1 Preferred Stock(1) | (1) | 05/15/2012 | C | 123,992 | (1) | (6) | Common Stock | 123,992 | (1) | 0 | I | See Footnote(2) | |||
| Series AA-1 Preferred Stock(1) | (1) | 05/15/2012 | C | 51,368 | (1) | (6) | Common Stock | 51,368 | (1) | 0 | I | See Footnote(3) | |||
| Series AA-1 Preferred Stock(1) | (1) | 05/15/2012 | C | 1,771 | (1) | (6) | Common Stock | 1,771 | (1) | 0 | I | See Footnote(4) | |||
| Series B Preferred Stock(1) | (1) | 05/15/2012 | C | 389,554 | (1) | (6) | Common Stock | 389,554 | (1) | 0 | I | See Footnote(2) | |||
| Series B Preferred Stock(1) | (1) | 05/15/2012 | C | 161,386 | (1) | (6) | Common Stock | 161,386 | (1) | 0 | I | See Footnote(3) | |||
| Series B Preferred Stock(1) | (1) | 05/15/2012 | C | 5,565 | (1) | (6) | Common Stock | 5,565 | (1) | 0 | I | See Footnote(4) | |||
| Series B-1 Preferred Stock(1) | (1) | 05/15/2012 | C | 181,767 | (1) | (6) | Common Stock | 181,767 | (1) | 0 | I | See Footnote(2) | |||
| Series B-1 Preferred Stock(1) | (1) | 05/15/2012 | C | 75,303 | (1) | (6) | Common Stock | 75,303 | (1) | 0 | I | See Footnote(3) | |||
| Series B-1 Preferred Stock(1) | (1) | 05/15/2012 | C | 2,596 | (1) | (6) | Common Stock | 2,596 | (1) | 0 | I | See Footnote(4) | |||
| Series C Preferred Stock(1) | (1) | 05/15/2012 | C | 355,798 | (1) | (6) | Common Stock | 355,798 | (1) | 0 | I | See Footnote(2) | |||
| Series C Preferred Stock(1) | (1) | 05/15/2012 | C | 147,402 | (1) | (6) | Common Stock | 147,402 | (1) | 0 | I | See Footnote(3) | |||
| Series C Preferred Stock(1) | (1) | 05/15/2012 | C | 5,082 | (1) | (6) | Common Stock | 5,082 | (1) | 0 | I | See Footnote(4) | |||
| Series D Preferred Stock(1) | (1) | 05/15/2012 | C | 5,695 | (1) | (6) | Common Stock | 5,695 | (1) | 0 | I | See Footnote(4) | |||
| Series D Preferred Stock(1) | (1) | 05/15/2012 | C | 1,133,312 | (1) | (6) | Common Stock | 1,133,312 | (1) | 0 | I | See Footnote(5) | |||
| Reporting Owner Name / Address | Relationships | |||
| Director | 10% Owner | Officer | Other | |
| TALLWOOD II LP C/O TALLWOOD VENTURE CAPITAL 3000 SAND HILL RD, BUILDING 3, SUITE 240 MENLO PARK, CA 94025 |
X | |||
| TALLWOOD II PARTNERS LP C/O TALLWOOD VENTURE CAPITAL 3000 SAND HILL RD, BUILDING 3, SUITE 240 MENLO PARK, CA 94025 |
X | |||
| TALLWOOD II ASSOCIATES LP C/O TALLWOOD VENTURE CAPITAL 3000 SAND HILL RD, BUILDING 3, SUITE 240 MENLO PARK, CA 94025 |
X | |||
| TALLWOOD II ANNEX LP C/O TALLWOOD VENTURE CAPITAL 3000 SAND HILL RD, BUILDING 3, SUITE 240 MENLO PARK, CA 94025 |
X | |||
| Tallwood II Management, LLC C/O TALLWOOD VENTURE CAPITAL 3000 SAND HILL RD, BUILDING 3, SUITE 240 MENLO PARK, CA 94025 |
X | |||
| /s/ Natasha Skok, as Atty-in-Fact for Tallwood II Management, LLC as General Partner for Tallwood II, L.P. | 05/17/2012 | |
| ** Signature of Reporting Person |
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| /s/ Natasha Skok, as Atty-in-Fact for Tallwood II Management, LLC as General Partner for Tallwood II Partners, L.P. | 05/17/2012 | |
| ** Signature of Reporting Person |
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| /s/ Natasha Skok, as Atty-in-Fact for Tallwood II Management, LLC as General Partner for Tallwood II Associates, L.P. | 05/17/2012 | |
| ** Signature of Reporting Person |
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| /s/ Natasha Skok, as Atty-in-Fact for Tallwood II Management, LLC as General Partner for Tallwood II Annex, L.P. | 05/17/2012 | |
| ** Signature of Reporting Person |
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| /s/ Natasha Skok, as Atty-in-Fact for Tallwood II Management, LLC | 05/17/2012 | |
| ** Signature of Reporting Person |
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| * | 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 share of Series AA, Series AA-1, Series B, Series B-1, Series C and Series D Preferred Stock automatically converted into one share of common stock immediately prior to the consummation of the Issuer's initial public offering. |
| (2) | The shares are held by Tallwood II, L.P. ("Tallwood II"). Tallwood II Management, LLC ("Tallwood II Management") is the general partner of Tallwood II. Tallwood II Management may be deemed to share voting and dispositive power with respect to the shares owned by Tallwood II, but disclaims beneficial ownership except to the extent of its pecuniary interest therein. |
| (3) | The shares are held by Tallwood II Partners, L.P. ("Tallwood II Partners"). Tallwood II Management is the general partner of Tallwood II Partners. Tallwood II Management may be deemed to share voting and dispositive power with respect to the shares owned by Tallwood II Partners, but disclaims beneficial ownership except to the extent of its pecuniary interest therein. |
| (4) | The shares are held by Tallwood II Associates, L.P. ("Tallwood II Associates"). Tallwood II Management is the general partner of Tallwood II Associates. Tallwood II Management may be deemed to share voting and dispositive power with respect to the shares owned by Tallwood II Associates, but disclaims beneficial ownership except to the extent of its pecuniary interest therein. |
| (5) | The shares are held by Tallwood II Annex, L.P. ("Tallwood II Annex"). Tallwood II Management is the general partner of Tallwood II Annex. Tallwood II Management may be deemed to share voting and dispositive power with respect to the shares owned by Tallwood II Annex, but disclaims beneficial ownership except to the extent of its pecuniary interest therein. |
| (6) | The expiration date is not relevant to the conversion of these securities. |