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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 | ||||||||
Series A Convertible Preferred Stock | (1) | 08/10/2005 | C | 98,135 | (1) | (1) | Common Stock | 98,135 | $ 0 (1) | 0 | D | ||||
Series B Convertible Preferred Stock | (1) | 08/10/2005 | C | 29,367 | (1) | (1) | Common Stock | 29,367 | $ 0 (1) | 0 | D | ||||
Series A Convertible Preferred Stock | (1) | 08/10/2005 | C | 397,809 | (1) | (1) | Common Stock | 397,809 | $ 0 (1) | 0 | I | Held by CLS I-IV, LLC (2) | |||
Series A Convertible Preferred Stock | (1) | 08/10/2005 | C | 4,771 | (1) | (1) | Common Stock | 4,771 | $ 0 (1) | 0 | I | Held by Charter Advisors Fund IV, L.P. (4) | |||
Series A Convertible Preferred Stock | (1) | 08/10/2005 | C | 15,130 | (1) | (1) | Common Stock | 15,130 | $ 0 (1) | 0 | I | Held by Charter Entrepreneurs Fund IV, L.P. (6) | |||
Series B Convertible Preferred Stock | (1) | 08/10/2005 | C | 351,691 | (1) | (1) | Common Stock | 351,691 | $ 0 (1) | 0 | I | Held by CLS I-IV, LLC (2) | |||
Series B Convertible Preferred Stock | (1) | 08/10/2005 | C | 4,218 | (1) | (1) | Common Stock | 4,218 | $ 0 (1) | 0 | I | Held by Charter Advisors Fund IV, L.P. (4) | |||
Series B Convertible Preferred Stock | (1) | 08/10/2005 | C | 13,376 | (1) | (1) | Common Stock | 13,376 | $ 0 (1) | 0 | I | Held by Charter Entrepreneurs Fund IV, L.P. (6) | |||
Preferred Stock Warrants (Right to Buy) | $ 5.43 | 08/10/2005 | C | 8,810 | 08/10/2005 | (3) | Series B Convertible Preferred Stock | 8,810 | $ 0 (5) | 0 | D | ||||
Preferred Stock Warrants (Right to Buy) | $ 5.43 | 08/10/2005 | C | 34,833 | 08/10/2005 | (3) | Series B Convertible Preferred Stock | 34,833 | $ 0 (5) | 0 | I | Held by CLS I-IV, LLC (2) | |||
Preferred Stock Warrants (Right to Buy) | $ 5.43 | 08/10/2005 | C | 661 | 08/10/2005 | (3) | Series B Convertible Preferred Stock | 661 | $ 0 (5) | 0 | I | Held by Charter Advisors Fund IV, L.P. (4) | |||
Preferred Stock Warrants (Right to Buy) | $ 5.43 | 08/10/2005 | C | 1,865 | 08/10/2005 | (3) | Series B Convertible Preferred Stock | 1,865 | $ 0 (5) | 0 | I | Held by Charter Entrepreneurs Fund IV, L.P. (6) | |||
Common Stock Warrants (Right to Buy) | $ 5.43 | 08/10/2005 | C | 8,810 | 08/10/2005 | (3) | Common Stock | 8,810 | $ 0 (5) | 8,810 | D | ||||
Common Stock Warrants (Right to Buy) | $ 5.43 | 08/10/2005 | C | 34,833 | 08/10/2005 | (3) | Common Stock | 34,833 | $ 0 (5) | 34,833 | I | Held by CLS I-IV, LLC (2) | |||
Common Stock Warrants (Right to Buy) | $ 5.43 | 08/10/2005 | C | 661 | 08/10/2005 | (3) | Common Stock | 661 | $ 0 (5) | 661 | I | Held by Charter Advisors Fund IV, L.P. (4) | |||
Common Stock Warrants (Right to Buy) | $ 5.43 | 08/10/2005 | C | 1,865 | 08/10/2005 | (3) | Common Stock | 1,865 | $ 0 (5) | 1,865 | I | Held by Charter Entrepreneurs Fund IV, L.P. (6) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HARRISON DONALD C 525 UNIVERSITY AVENUE, SUITE 1400 PALO ALTO, CA 94301 |
X |
/s/ Thomas J. Etergino as Attorney-in-Fact for Donald C. Harrison | 08/15/2005 | |
**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) | The shares of Preferred Stock automatically converted on a 1-for-1 basis into Common Stock upon the closing of the Issuer's initial public offering. |
(2) | Dr. Harrison is a manager of CLS I-IV, LLC and disclaims beneficial ownership of the securities held by this entity, except as to his pecuniary interest therein. |
(3) | Warrants expire on August 10, 2006 (one year from the date of the Issuer's initial public offering). |
(4) | Dr. Harrison disclaims beneficial ownership of the securities held by this entity, except as to his pecuniary interest therein. |
(5) | The shares of Series B Convertible Preferred Stock issuable upon conversion of the Warrants automatically converted on a 1-for-1 basis into Common Stock upon the closing of the Issuer's initial public offering. |
(6) | Dr. Harrison disclaims beneficial ownership of the securities held by this entity, except as to his pecuniary interest therein. |