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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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SOFINNOVA VENTURE PARTNERS VI L P 2800 SAND HILL ROAD, SUITE 150 MENLO PARK, CA 94025 |
X | |||
Sofinnova Management VI, L.L.C. 2800 SAND HILL ROAD, SUITE 150 MENLO PARK, CA 94025 |
X | |||
Sofinnova Venture Partners VI GmbH & Co. KG 2800 SAND HILL ROAD, SUITE 150 MENLO PARK, CA 94025 |
X | |||
Sofinnova Venture Affiliates VI LP 2800 SAND HILL ROAD, SUITE 150 MENLO PARK, CA 94025 |
X | |||
Azan Alain 2800 SAND HILL ROAD, SUITE 150 MENLO PARK, CA 94025 |
X | |||
POWELL MICHAEL C/O SOFINNOVA VENTURES 2800 SAND HILL ROAD, SUITE 150 MENLO PARK, CA 94025 |
X | |||
Buatois Eric C/O SOFINNOVA VENTURES 2800 SAND HILL ROAD, SUITE 150 MENLO PARK, CA 94025 |
X |
/s/ Nathalie Auber, Attorney-in-Fact for Sofinnova Venture Partners VI, L.P. | 01/03/2012 | |
**Signature of Reporting Person | Date | |
/s/ Nathalie Auber, Attorney-in-Fact for Sofinnova Venture Partners VI GmbH & Co. KG | 01/03/2012 | |
**Signature of Reporting Person | Date | |
/s/ Nathalie Auber, Attorney-in-Fact for Sofinnova Venture Affiliates VI, L.P. | 01/03/2012 | |
**Signature of Reporting Person | Date | |
/s/ Nathalie Auber, Attorney-in-Fact for Sofinnova Management VI, L.L.C. | 01/03/2012 | |
**Signature of Reporting Person | Date | |
/s/ Nathalie Auber, Attorney-in-Fact for Michael F. Powell | 01/03/2012 | |
**Signature of Reporting Person | Date | |
/s/ Nathalie Auber, Attorney-in-Fact for Alain L. Azan | 01/03/2012 | |
**Signature of Reporting Person | Date | |
/s/ Nathalie Auber, Attorney-in-Fact for Eric P. Buatois | 01/03/2012 | |
**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) | Shares are held by Sofinnova Venture Partners VI, L.P. ("SV VI"). Sofinnova Management VI, L.L.C. ("SV LLC") is the general partner of SV VI and James I. Healy ("Healy"), a director of the issuer, Michael F. Powell ("Powell"), Alain L. Azan ("Azan") and Eric P. Buatois ("Buatois"), the managing members of SV LLC, may be deemed to share voting and dispositive power over the shares held by such entities. |
(2) | Shares are held by Sofinnova Venture Partners VI GmbH & Co. KG ("SV KG"). SV LLC is the general partner of SV KG, and Healy, Powell, Azan and Buatois, the managing members of SV LLC, may be deemed to share voting and dispositive power over the shares held by such entities. |
(3) | Shares are held by Sofinnova Venture Affiliates VI L.P. ("SV A"). SV LLC is the general partner of SV A, and Healy, Powell, Azan and Buatois, the managing members of SV LLC, may be deemed to share voting and dispositive power over the shares held by such entities. |
Remarks: SV LLC and its managing members disclaim benefical ownership of these shares except to the extent of any pecuniary interest therein, and the filing of this report is not an admission that SV LLC or any of its managing members is the beneficial owner of these shares for purposes of Section 16 or for any other purpose. |