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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series 1 Preferred Stock (Convertible) | (1) | 03/12/2014 | C | 1,916,509 | (1) | (2) | Common Stock | 1,916,509 | $ 0 | 0 | I | See footnote (3) | |||
Series A-2 Preferred Stock (Convertible) | (1) | 03/12/2014 | C | 302,679 | (1) | (2) | Common Stock | 302,679 | $ 0 | 0 | I | See footnote (3) | |||
Series A-3 Preferred Stock (Convertible) | (1) | 03/12/2014 | C | 2,599,858 | (1) | (2) | Common Stock | 2,599,858 | $ 0 | 0 | I | See footnote (3) | |||
Series A-4 Preferred Stock (Convertible) | (1) | 03/12/2014 | C | 1,629,035 | (1) | (2) | Common Stock | 1,629,035 | $ 0 | 0 | I | See footnote (3) | |||
Series A-5 Preferred Stock (Convertible) | (1) | 03/12/2014 | C | 5,342,513 | (1) | (2) | Common Stock | 5,342,513 | $ 0 | 0 | I | See footnote (3) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Burbank John Howard III ONE MARKET STREET STEUART TOWER, STE. 2200 SAN FRANCISCO, CA 94105 |
X |
/s/ John H. Burbank III | 03/14/2014 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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 Preferred Stock automatically converted into one share of Common Stock immediately prior to the closing of the Issuer's initial public offering. |
(2) | The shares of this series of Preferred Stock have no expiration date. |
(3) | Shares held directly by JHB Ventures, LLC. John H. Burbank III serves as the managing member of JHB Ventures, LLC and, in such capacity, has sole voting and investment power over the shares held by JHB Ventures, LLC. |
(4) | Shares held directly by Passport Ventures II, LLC. John H. Burbank III serves as the managing member of Passport Ventures II, LLC and in such capacity, has sole voting and investment power over the shares held by Passport Ventures II, LLC. Mr. Burbank disclaims beneficial ownership of the shares held directly by Passport Ventures II, LLC except to the extent of his pecuniary interest therein. |