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
(2)
|
Â
(2)
|
Common Stock
|
15,592
(3)
|
$
(3)
|
D
|
Â
|
Series A Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
7,368
(3)
|
$
(3)
|
I
|
By Abram Investments LLC
|
Series B Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
12,500
(4)
|
$
(4)
|
D
|
Â
|
Series B Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
3,750
(4)
|
$
(4)
|
I
|
By Abram Investments LLC
|
Series B Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
3,750
(4)
|
$
(4)
|
I
|
By Mother
|
Options to Purchase Common Stock
|
Â
(5)
|
03/24/2014 |
Common Stock
|
11,313
(1)
(5)
|
$
100
(1)
|
D
|
Â
|
Options to Purchase Common Stock
|
Â
(6)
|
12/16/2014 |
Common Stock
|
711
(1)
(6)
|
$
125
(1)
|
D
|
Â
|
Options to Purchase Common Stock
|
Â
(7)
|
05/14/2013 |
Common Stock
|
40,606
(1)
(7)
|
$
100
(1)
|
D
|
Â
|
Warrants to Purchase Common Stock
|
Â
(8)
|
10/31/2013 |
Common Stock
|
8,750
(1)
|
$
100
(1)
|
D
|
Â
|
* |
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) |
Does not reflect a 10-for-1 stock split to be effective prior to the closing of the issuer's initial public offering. |
(2) |
All of the issuer's Series A Convertible Preferred Stock and Series B Convertible Preferred Stock will be converted into
Common Stock immediately prior to the closing of the issuer's initial public offering. |
(3) |
Does not reflect accrued and unpaid dividends payable in Common Stock or a 10-for-1 stock split to be effective prior to the
closing of the issuer's initial public offering. |
(4) |
Does not reflect accrued and unpaid dividends payable in Common Stock or a 10-for-1 stock split to be effective prior to the
closing of the issuer's initial public offering. |
(5) |
Of these 11,313 Options to Purchase Common Stock, 2,828 have vested, and the remainder will vest in equal installments on
each of 3/25/06, 3/25/07 and 3/25/08. |
(6) |
Of these 711 Options to Purchase Common Stock, none have vested, and the remainder will vest in equal installments on each of
12/17/05, 12/17/06, 12/17/07 and 12/17/08. |
(7) |
Of these 40,606 Options to Purchase Common Stock, 20,302 have vested, and the remainder will vest in equal installments on
each of 5/15/06 and 5/15/07. |
(8) |
The Warrants are curretnly exercisable. |