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
|
Â
(4)
|
Â
(4)
|
Common Stock
|
3,673,730
|
$
(4)
|
I
|
By Maveron Equity Partners III, L.P.
(1)
|
Series A Convertible Preferred Stock
|
Â
(4)
|
Â
(4)
|
Common Stock
|
155,880
|
$
(4)
|
I
|
By Maveron III Entrepreneurs? Fund L.P.
(2)
|
Series A Convertible Preferred Stock
|
Â
(4)
|
Â
(4)
|
Common Stock
|
503,720
|
$
(4)
|
I
|
By MEP Associates III, L.P.
(3)
|
Series B Convertible Preferred Stock
|
Â
(5)
|
Â
(5)
|
Common Stock
|
1,210,920
|
$
(5)
|
I
|
By Maveron Equity Partners III, L.P.
(1)
|
Series B Convertible Preferred Stock
|
Â
(5)
|
Â
(5)
|
Common Stock
|
51,364
|
$
(5)
|
I
|
By Maveron III Entrepreneurs? Fund L.P.
(2)
|
Series B Convertible Preferred Stock
|
Â
(5)
|
Â
(5)
|
Common Stock
|
166,032
|
$
(5)
|
I
|
By MEP Associates III, L.P.
(3)
|
Series C Convertible Preferred Stock
|
Â
(6)
|
Â
(6)
|
Common Stock
|
545,165
|
$
(6)
|
I
|
By Maveron Equity Partners III, L.P.
(1)
|
Series C Convertible Preferred Stock
|
Â
(6)
|
Â
(6)
|
Common Stock
|
23,131
|
$
(6)
|
I
|
By Maveron III Entrepreneurs? Fund L.P.
(2)
|
Series C Convertible Preferred Stock
|
Â
(6)
|
Â
(6)
|
Common Stock
|
74,750
|
$
(6)
|
I
|
By MEP Associates III, L.P.
(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 reporting person, together with Clayton Lewis, Peter McCormick and Jason Stoffer, are members of Maveron General Partner III LLC ("Maveron LLC"), which is the general partner of Maveron Equity Partners III, L.P. ("Maveron Equity"), and may be deemed to share voting and investment power over the securities held by Maveron Equity. The reporting person disclaims beneficial ownership over such securities except to the extent of his pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes. |
(2) |
The reporting person, together with Clayton Lewis, Peter McCormick and Jason Stoffer, are members of Maveron LLC, which is the General Partner of Maveron III Entrepreneurs' Fund L.P. ("Maveron Entrepreneurs"), and may be deemed to share voting and investment power over the securities held by Maveron Entrepreneurs. The reporting person disclaims beneficial ownership over such securities except to the extent of his pecuniary interest therein. The inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes. |
(3) |
The reporting person, together with Clayton Lewis, Peter McCormick and Jason Stoffer, are members of Maveron LLC, which is the General Partner of MEP Associates III, L.P. ("MEP"), and may be deemed to share voting and investment power over the securities held by MEP. The reporting person disclaims beneficial ownership over such securities except to the extent of his pecuniary interest therein. The inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes. |
(4) |
Each share of the issuer's Series A Convertible Preferred Stock will be converted into 1 share of the issuer's Common Stock immediately upon the closing of the issuer's initial public offering ("IPO") and has no expiration date. |
(5) |
Each share of the issuer's Series B Convertible Preferred Stock will be converted into 1 share of the issuer's Common Stock immediately upon the closing of the issuer's IPO and has no expiration date. |
(6) |
Each share of the issuer's Series C Convertible Preferred Stock will be converted into 1 share of the issuer's Common Stock immediately upon the closing of the issuer's IPO and has no expiration date. |