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
|
356,111
|
$
(1)
|
I
|
By Domain Partners VII, L.P.
(4)
|
Series C Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
549,833
|
$
(1)
|
I
|
By Domain Partners VII, L.P.
(4)
|
Series D Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
2,283,114
|
$
(1)
|
I
|
By Domain Partners VII, L.P.
(4)
|
Warrant to Purchase Series D Preferred Stock
|
Â
(2)
|
Â
(2)
|
Series D Preferred Stock
(3)
|
590,403
(3)
|
$
4.4
(3)
|
I
|
By Domain Partners VII, L.P.
(4)
|
Series B Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
6,071
|
$
(1)
|
I
|
By DP VII Associates, L.P.
(4)
|
Series C Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
9,378
|
$
(1)
|
I
|
By DP VII Associates, L.P.
(4)
|
Series D Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
38,941
|
$
(1)
|
I
|
By DP VII Associates, L.P.
(4)
|
Warrant to Purchase Series D Preferred Stock
|
Â
(5)
|
Â
(5)
|
Series D Preferred Stock
(3)
|
10,068
(3)
|
$
4.4
(3)
|
I
|
By DP VII Associates, L.P.
(4)
|
* |
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) |
All outstanding shares of the Issuer's preferred stock will automatically convert into Common Stock upon the closing of the Issuer's initial public offering (the "IPO"), for no additional consideration. The preferred stock has no expiration date. The Common Stock equivalents of the preferred stock reflect the 1 for 1.6756 reverse split of the Common Stock effected in November 2013. |
(2) |
The Warrant is immediately exercisable and expires as follows: 362,965 shares on 8/17/21; 90,741 shares on 5/25/22; and 136,697 shares on 7/17/22. |
(3) |
Upon the closing of the IPO the Warrants to purchase Series D Preferred Stock will automatically convert into Warrants to purchase the number of shares of Common Stock that the Series D Preferred Stock underlying the Warrants will convert into, subject to the reverse split described in footnote (1), and the exercise price will accordingly adjust to $7.37 per share. |
(4) |
The Reporting Person is a Managing Member of One Palmer Square Associates VII, LLC, which is the sole general partner of Domain Partners VII, L.P. and DP VII Associates, L.P. Pursuant to Instruction (5)(b)(iv) of Form 3, the Reporting Person has elected to report as indirectly beneficially owned the entire number of securities beneficially owned by each such entity. The Reporting Person disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his or her pecuniary interest therein and/or that are not actually distributed to him or her. |
(5) |
The Warrant is immediately exercisable and expires as follows: 6,190 shares on 8/17/21; 1,547 shares on 5/25/22; and 2,331 shares on 7/17/22. |