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 A Convertible Preferred Stock
|
Â
(2)
|
Â
(3)
|
Common Stock
|
168,621
|
$
0
(2)
|
I
|
By CID Equity Fund V Liquidating Trust
(1)
|
Series B Convertible Preferred Stock
|
Â
(2)
|
Â
(3)
|
Common Stock
|
181,278
|
$
0
(2)
|
I
|
By CID Equity Fund V Liquidating Trust
(1)
|
Series A Convertible Preferred Stock
|
Â
(2)
|
Â
(3)
|
Common Stock
|
82,102
|
$
0
(2)
|
I
|
By CID Mezzanine Capital, L.P.
(4)
|
Series B Convertible Preferred Stock
|
Â
(2)
|
Â
(3)
|
Common Stock
|
1,252,962
|
$
0
(2)
|
I
|
By CID Mezzanine Capital, L.P.
(4)
|
Series C Convertible Preferred Stock
|
Â
(2)
|
Â
(3)
|
Common Stock
|
240,765
|
$
0
(2)
|
I
|
By CID Mezzanine Capital, 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) |
Represents securities held directly by CID Equity Fund V Liquidating Trust. CID Equity Partners V is the trustee of the CID Equity Fund V Liquidating Trust and Aplin Partners, LLC is the general partner of CID Equity Partners V. The reporting person is a representative to an advisory board that affects the voting and disposition of the shares. The reporting person may be deemed to be an indirect beneficial owner of the reported securities. The reporting person disclaims any beneficial ownership of the reported securities, except to the extent of any pecuniary interest therein. This report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. |
(2) |
Each share of Series A, Series B, and Series C Convertible Preferred Stock is convertible at any time at the option of the holder, and will automatically convert into shares of the Issuer's Common Stock on a one-for-one basis in connection with the closing of the Issuer's initial public offering. |
(3) |
The securities do not have an expiration date. The securities will automatically convert into shares of the Issuer's Common Stock on a one-for-one basis in connection with the closing of the Issuer's initial public offering. |
(4) |
Represents securities held directly by CID Mezzanine Capital, L.P, which is managed by CID Mezzanine Partners, L.P. The reporting person is a representative to an advisory board that affects the voting and disposition of the shares. The reporting person may be deemed to be an indirect beneficial owner of the reported securities. The reporting person disclaims any beneficial ownership of the reported securities, except to the extent of any pecuniary interest therein. This report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. |