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 |
Warrants (right to buy)
|
09/30/2013 |
09/30/2018 |
Common Stock
|
4,613
|
$
5.75
|
I
|
By Alta BioPharma Partners III GmbH & Co. Beteiligungs KG
(1)
|
Warrants (right to buy)
|
09/30/2013 |
09/30/2018 |
Common Stock
|
68,693
|
$
5.75
|
I
|
By Alta BioPharma Partners III, L.P.
(2)
|
Warrants (right to buy)
|
09/30/2013 |
09/30/2018 |
Common Stock
|
1,692
|
$
5.75
|
I
|
By Alta Embarcadero BioPharma Partners III, LLC
(3)
|
* |
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) |
The securities are held by Alta BioPharma Partners III GmbH & Co. Beteiligungs KG ("ABP III KG"). The Reporting Person disclaims beneficial ownership of the securities held by the entities associated with ABP III KG, Alta BioPharma Partners III, L.P. ("ABP III"), and Alta Embarcadero BioPharma Partners III, LLC ("AEBP III"), except to the extent of his ability to direct the voting or disposition of such securities or his pecuniary interest therein. |
(2) |
The securities are held by ABP III. The Reporting Person disclaims beneficial ownership of the securities held by the entities associated with ABP III KG, ABP III, and AEBP III, except to the extent of his ability to direct the voting or disposition of such securities or his pecuniary interest therein. |
(3) |
The securities are held by AEBP III. The Reporting Person disclaims beneficial ownership of the securities held by the entities associated with ABP III KG, ABP III, and AEBP III, except to the extent of his ability to direct the voting or disposition of such securities or his pecuniary interest therein. |