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-1 Convertible Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
139,395
|
$
(1)
|
I
|
See footnote
(2)
|
Series A-2 Convertible Preferred Stock
|
Â
(3)
|
Â
(3)
|
Common Stock
|
331,158
|
$
(3)
|
I
|
See footnote
(2)
|
Series B Preferred Convertible Preferred Stock
|
Â
(4)
|
Â
(4)
|
Common Stock
|
561,470
|
$
(4)
|
I
|
See footnote
(2)
|
Series C Preferred Convertible Preferred Stock
|
Â
(5)
|
Â
(5)
|
Common Stock
|
70,196
|
$
(5)
|
I
|
See footnote
(2)
|
Series D Preferred Convertible Preferred Stock
|
Â
(6)
|
Â
(6)
|
Common Stock
|
52,902
|
$
(6)
|
I
|
See footnote
(2)
|
Warrant to Purchase Series A-1 Stock (right to buy)
|
Â
(7)
|
11/16/2015 |
Series A-1 Convertible Preferred Stock
(8)
|
14,934
|
$
12.55
|
I
|
See footnote
(2)
|
Warrant to Purchase Series A-1 Stock (right to buy)
|
Â
(7)
|
10/26/2016 |
Series A-1 Convertible Preferred Stock
(8)
|
9,956
|
$
12.55
|
I
|
See footnote
(2)
|
Warrant to Purchase Series A-1 Stock (right to buy)
|
Â
(7)
|
05/03/2017 |
Series A-1 Convertible Preferred Stock
(8)
|
32,856
|
$
12.55
|
I
|
See footnote
(2)
|
Warrant to Purchase Series A-1 Stock (right to buy)
|
Â
(7)
|
08/28/2018 |
Series A-1 Convertible Preferred Stock
(8)
|
7,467
|
$
12.55
|
I
|
See footnote
(2)
|
Warrant to Purchase Series A-1 Stock (right to buy)
|
Â
(7)
|
12/18/2018 |
Series A-1 Convertible Preferred Stock
(8)
|
7,467
|
$
12.55
|
I
|
See footnote
(2)
|
Warrant to Purchase Series A-1 Stock (right to buy)
|
Â
(7)
|
04/15/2019 |
Series A-1 Convertible Preferred Stock
(8)
|
14,634
|
$
12.55
|
I
|
See footnote
(2)
|
Warrant to Purchase Series B Stock (right to buy)
|
Â
(7)
|
04/15/2019 |
Series B Convertible Preferred Stock
(9)
|
9,091
|
$
6.19
|
I
|
See footnote
(2)
|
* |
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 Series A-1 Convertible Preferred Stock is convertible into Common Stock on an 18.967-for-one basis into the number of shares of Common Stock as shown in column 3 at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. |
(2) |
The securities are held directly by Cooperative AAC LS U.A. ("Cooperative"). The Reporting Person is a director of Cooperative and disclaims beneficial ownership of all shares held by the foregoing entity except to the extent of his pecuniary interest therein. |
(3) |
The Series A-2 Convertible Preferred Stock is convertible into Common Stock on an 18.967-for-one basis into the number of shares of Common Stock as shown in column 3 at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. |
(4) |
The Series B Convertible Preferred Stock is convertible into Common Stock on an 18.967-for-one basis into the number of shares of Common Stock as shown in column 3 at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. |
(5) |
The Series C Convertible Preferred Stock is convertible into Common Stock on an 18.967-for-one basis into the number of shares of Common Stock as shown in column 3 at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. |
(6) |
The Series D Convertible Preferred Stock is convertible into Common Stock on an 18.967-for-one basis into the number of shares of Common Stock as shown in column 3 at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. |
(7) |
This warrant is immediately exercisable. |
(8) |
Upon completion of the Issuer's initial public offering, this warrant to purchase shares of Series A-1 Convertible Preferred Stock will automatically convert on an 18.967-for-one basis into a warrant to purchase shares of Common Stock. |
(9) |
Upon completion of the Issuer's initial public offering, this warrant to purchase shares of Series B Convertible Preferred Stock will automatically convert on an 18.967-for-one basis into a warrant to purchase shares of Common Stock. |