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
|
(1)
|
(1)
|
Common Stock
|
85,015
|
$
(1)
|
I
|
By Michael A. & Linda A. Fitzpatrick Family Trust dated 10/13/1997
(2)
|
Series C Preferred Stock
|
(3)
|
(3)
|
Common Stock
|
94,633
|
$
(3)
|
I
|
By Michael A. & Linda A. Fitzpatrick Family Trust dated 10/13/1997
(2)
|
Series D Preferred Stock
|
(4)
|
(4)
|
Common Stock
|
48,595
|
$
(4)
|
I
|
By Michael A. & Linda A. Fitzpatrick Family Trust dated 10/13/1997
(2)
|
Series C Preferred Stock Warrant (right to buy)
|
(5)
|
(5)
|
Series C Preferred Stock
|
2,800
|
$
0.4797
(6)
|
I
|
By Michael A. & Linda A. Fitzpatrick Family Trust dated 10/13/1997
(2)
|
Stock Option (right to buy Common Stock)
|
(7)
|
09/08/2019 |
Common Stock
|
826
|
$
5.09
|
D
|
|
Stock Option (right to buy Common Stock)
|
(7)
|
02/08/2021 |
Common Stock
|
1,652
|
$
4.36
|
D
|
|
Stock Option (right to buy Common Stock)
|
(7)
|
04/24/2023 |
Common Stock
|
2,066
|
$
5.81
|
D
|
|
Stock Option (right to buy Common Stock)
|
(8)
|
09/27/2025 |
Common Stock
|
15,068
|
$
11.98
|
D
|
|
* |
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) |
Each share of the issuer's Series B Preferred Stock will automatically convert into 0.0578 share of the issuer's Common Stock immediately upon the closing of the issuer's initial public offering ("IPO") and has no expiration date. |
(2) |
These securities are held of record by Michael A. Fitzpatrick and Linda A. Fitzpatrick, Trustees of the Michael A. & Linda A. Fitzpatrick Family Trust dated 10/13/1997. |
(3) |
Each share of the issuer's Series C Preferred Stock will automatically convert into 0.0370 share of the issuer's Common Stock immediately upon the closing of the issuer's IPO and has no expiration date. |
(4) |
Each share of the issuer's Series D Preferred Stock will automatically convert into 0.0405 share of the issuer's Common Stock immediately upon the closing of the issuer's IPO and has no expiration date. |
(5) |
The warrant is exercisable at any time at the holder's election on a one-for one basis and automatically terminates on the completion of the issuer's initial public offering if not earlier exercised. |
(6) |
The warrant has a net exercise provision under which the holder, in lieu of paying the exercise price in cash, can surrender the warrant and receive a net number of shares of preferred stock based on the fair market value of such stock at the time of exercise, after deducting the aggregate exercise price. |
(7) |
The option is fully vested. |
(8) |
The option vests as to 2.0833% of the total shares monthly, beginning on October 15, 2015, with 100% of the total shares vested and exercisable on September 15, 2019, subject to the reporting person's provision of service to the issuer on each vesting date. |