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 C Convertible Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
120,161
|
$
(1)
|
D
|
Â
|
Series D Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
28,571
|
$
(2)
|
D
|
Â
|
Series E Convertible Preferred Stock
|
Â
(3)
|
Â
(3)
|
Common Stock
|
222,222
|
$
(3)
|
D
|
Â
|
Series F Convertible Preferred Stock
|
Â
(4)
|
Â
(4)
|
Common Stock
|
136,058
|
$
(4)
|
D
|
Â
|
Series G Convertible Preferred Stock
|
Â
(5)
|
Â
(5)
|
Common Stock
|
25,000
|
$
(5)
|
D
|
Â
|
Series C Convertible Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
30,040
|
$
(1)
|
I
|
By Husband
|
Series D Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
14,286
|
$
(2)
|
I
|
By Husband
|
Series E Convertible Preferred Stock
|
Â
(3)
|
Â
(3)
|
Common Stock
|
188,889
|
$
(3)
|
I
|
By Husband
|
Series F Convertible Preferred Stock
|
Â
(4)
|
Â
(4)
|
Common Stock
|
19,607
|
$
(4)
|
I
|
By Husband
|
Series G Convertible Preferred Stock
|
Â
(5)
|
Â
(5)
|
Common Stock
|
7,000
|
$
(5)
|
I
|
By Husband
|
Series F Convertible Preferred Stock
|
Â
(4)
|
Â
(4)
|
Common Stock
|
64,448
|
$
(4)
|
I
|
By Trust
|
Series F Convertible Preferred Stock
|
Â
(4)
|
Â
(4)
|
Common Stock
|
6,552
|
$
(4)
|
I
|
By Trust
|
Stock Option (right to buy)
|
Â
(6)
|
05/07/2016 |
Common Stock
|
60,000
|
$
2.47
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(6)
|
08/01/2016 |
Common Stock
|
20,000
|
$
2.47
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(6)
|
10/04/2017 |
Common Stock
|
20,000
|
$
2.59
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(6)
|
09/21/2018 |
Common Stock
|
20,000
|
$
1.81
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(6)
|
11/04/2019 |
Common Stock
|
20,000
|
$
2.12
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(6)
|
05/02/2021 |
Common Stock
|
53,000
|
$
5.54
|
D
|
Â
|
* |
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 Series C Convertible Preferred Stock will automatically convert into one share of Common Stock upon the closing of the issuer's initial public offering. The shares have no expiration date. |
(2) |
Each share of Series D Convertible Preferred Stock will automatically convert into one share of Common Stock upon the closing of the issuer's initial public offering. The shares have no expiration date. |
(3) |
Each share of Series E Convertible Preferred Stock will automatically convert into one share of Common Stock upon the closing of the issuer's initial public offering. The shares have no expiration date. |
(4) |
Each share of Series F Convertible Preferred Stock will automatically convert into one share of Common Stock upon the closing of the issuer's initial public offering. The shares have no expiration date. |
(5) |
Each share of Series G Convertible Preferred Stock will automatically convert into one share of Common Stock upon the closing of the issuer's initial public offering. The shares have no expiration date. |
(6) |
This option is fully vested. |