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 E-4 Convertible Preferred Stock
|
Â
(1)
|
Â
(2)
|
Common Stock
|
1,539,343
(3)
(4)
|
$
(1)
(4)
|
I
|
See Footnote
(5)
|
Series E-5 Convertible Preferred Stock
|
Â
(1)
|
Â
(2)
|
Common Stock
|
500,039
(3)
(4)
|
$
(1)
(4)
|
I
|
See Footnote
(5)
|
Convertible Promissory Notes
|
Â
(6)
|
Â
(6)
|
Common Stock
|
658,551
(6)
|
$
(6)
|
I
|
See Footnote
(5)
|
Warrant to Purchase Common Stock
|
Â
(7)
|
Â
(7)
|
Common Stock
|
398,717
(3)
(7)
|
$
(8)
|
I
|
See Footnote
(5)
|
* |
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) |
Immediately convertible into shares of the Issuer's Common Stock. |
(2) |
These shares have no expiration date. |
(3) |
Reflect a 1-for-15 reverse stock split of the Company's issued and outstanding securities effective February 3, 2014. |
(4) |
Each share shall automatically convert into 1 share of the Issuer's Common Stock immediately prior to the closing of the Issuer's initial public offering. |
(5) |
These securities are held by NovaQuest Pharma Opportunities Fund III, L.P. ("NovaQuest"). NQ HCIF General Partner, L.P., the general partner of NovaQuest ("NovaQuest GP"), has the power to vote and dispose of securities directly owned by NovaQuest, and NQ HCIF GP, Ltd., the general partner of NovaQuest GP ("NovaQuest GP Ltd."), has the power to direct the NovaQuest GP as to such voting and disposition. NovaQuest GP Ltd.'s investment committee, on which the Reporting Person, Ronald Wooten, serves, makes voting and investment decisions regarding securities held by NovaQuest. Mr. Wooten also serves on the board of directors of NovaQuest GP Ltd. Accordingly, Mr. Wooten may be deemed to have shared voting and dispositive power over the securities held by NovaQuest. Mr. Wooten disclaims beneficial ownership of the securities held by NovaQuest except to the extent of his pecuniary interest therein. |
(6) |
Principal amount of $9,500,000.00 plus interest accrued through October 7, 2014, at the rate of 12% per annum shall convert automatically upon the closing of the Issuer's initial public offering into shares of Common Stock at a conversion price that equals to 100% of the per share price of the Common Stock sold in the Issuer's initial public offering. |
(7) |
Automatically net exercisable contingent upon and effective immediately prior to the closing of the Issuer's initial public offering. |
(8) |
The exercise price is $0.15 per share which reflects the 1-for-15 reverse split effective February 3, 2014. |