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
|
04/15/2002 |
Â
(2)
|
Common Stock
|
83,278
(2)
|
$
0
(2)
|
D
|
Â
|
Series A Convertible Preferred Stock
|
04/15/2002 |
Â
(2)
|
Common Stock
|
5,611
(2)
|
$
0
(2)
|
I
|
CHL Medical Partners II Side Fund, L.P.
(1)
|
Series A Convertible Preferred Stock
|
07/15/2002 |
Â
(2)
|
Common Stock
|
333,111
|
$
0
(2)
|
D
|
Â
|
Series A Convertible Preferred Stock
|
07/15/2002 |
Â
(2)
|
Common Stock
|
22,444
|
$
0
(2)
|
I
|
CHL Medical Partners II Side Fund, L.P.
(1)
|
Series B Convertible Preferred Stock
|
05/04/2005 |
Â
(2)
|
Common Stock
|
734,803
(2)
|
$
0
(2)
|
D
|
Â
|
Series B Convertible Preferred Stock
|
05/04/2005 |
Â
(2)
|
Common Stock
|
49,509
(2)
|
$
0
(2)
|
I
|
CHL Medical Partners II Side Fund, L.P.
(1)
|
Series B Convertible Preferred Stock
|
04/18/2006 |
Â
(2)
|
Common Stock
|
11,182
(2)
|
$
0
(2)
|
D
|
Â
|
Series B Convertible Preferred Stock
|
04/18/2006 |
Â
(2)
|
Common Stock
|
753
(2)
|
$
0
(2)
|
I
|
CHL Medical Partners II Side Fund, L.P.
(1)
|
Series C Convertible Preferred Stock
|
08/16/2005 |
Â
(2)
|
Common Stock
|
247,850
(2)
|
$
0
(2)
|
D
|
Â
|
Series C Convertible Preferred Stock
|
08/16/2005 |
Â
(2)
|
Common Stock
|
16,699
(2)
|
$
0
(2)
|
I
|
CHL Medical Partners II Side Fund, L.P.
(1)
|
Series C Convertible Preferred Stock
|
04/17/2006 |
Â
(2)
|
Common Stock
|
247,850
(2)
|
$
0
(2)
|
D
|
Â
|
Series C Convertible Preferred Stock
|
04/17/2006 |
Â
(2)
|
Common Stock
|
16,699
(2)
|
$
0
(2)
|
I
|
CHL Medical Partners II Side Fund, L.P.
(1)
|
Series D Convertible Preferred Stock
|
09/13/2006 |
Â
(2)
|
Common Stock
|
96,233
(2)
|
$
0
(2)
|
D
|
Â
|
Series D Convertible Preferred Stock
|
09/13/2006 |
Â
(2)
|
Common Stock
|
6,484
(2)
|
$
0
(2)
|
I
|
CHL Medical Partners II Side Fund, L.P.
(1)
|
Series D Convertible Preferred Stock
|
03/09/2007 |
Â
(2)
|
Common Stock
|
96,233
(2)
|
$
0
(2)
|
D
|
Â
|
Series D Convertible Preferred Stock
|
03/09/2007 |
Â
(2)
|
Common Stock
|
6,484
(2)
|
$
0
(2)
|
I
|
CHL Medical Partners II Side Fund, L.P.
|
* |
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) |
These shares are owned by CHL Medical Partners II Side Fund, L.P., which is under common control with CHL Medical Partners II, L.P. Collinson, Howe & Lennox II, L.L.C. serves as the sole general partner of CHL Medical Partners II Side Fund, L.P. and CHL Medical Partners II, L.P. and is the indirect beneficial owner of these shares. CHL Medical Partners II, L.P. disclaims beneficial ownership of such shares except to the extent of its pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of the shares for purposes of section 16 or for any other purpose. |
(2) |
Each share is convertible and will automatically convert on a 1-for-1 basis into the Issuer's common stock upon the closing of the Issuer's initial public offering of common stock pursuant to an effective registration statement filed with the U.S. Securities and Exchange Commission. These shares have no expiration date. |