UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 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. | SEC 1473 (7-02) | ||
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. |
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) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Warrants | 08/01/2017 | 08/01/2024 | Common Stock | 19,310 | $ 6.8423 | I (1) | Held by Sante Health Ventures I, L.P. (1) |
Warrants | 08/01/2017 | 08/01/2024 | Common Stock | 4,827 | $ 6.8423 | I (1) | Held by Sante Health Ventures I Annex Fund, L.P. (1) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SHV Management Services, LLC C/O SANTE VENTURES 300 W 6TH STREET, SUITE 2300 AUSTIN, TX 78701 |
X | |||
Cunningham Joe H C/O SANTE VENTURES 300 W 6TH STREET, SUITE 2300 AUSTIN 78701 |
X | |||
FRENCH DOUGLAS D C/O SANTE VENTURES 300 W 6TH STREET, SUITE 2300 AUSTIN, TX 78701 |
X | |||
SHV Management Services, LP 300 W 6TH STREET, SUITE 2300 AUSTIN, TX 78701 |
X | |||
SANTE HEALTH VENTURES I LP 300 W 6TH STREET, SUITE 2300 AUSTIN, TX 78701 |
X | |||
Sante Health Ventures I Annex Fund, LP 300 W 6TH STREET, SUITE 2300 AUSTIN, TX 78701 |
X |
SHV MANAGEMENT SERVICES, LLC, By: Kevin Lalande, Its Managing Member, By: /s/ Jason S. Kim, Attorney in fact | 08/11/2017 | |
**Signature of Reporting Person | Date | |
SHV MANAGEMENT SERVICES, L.P., By: SHV Management Services, LLC, Its general partner, By: Kevin Lalande, Its Managing Member, By: /s/ Jason S. Kim, Attorney in fact | 08/11/2017 | |
**Signature of Reporting Person | Date | |
SANTE HEALTH VENTURES I, L.P., By: SHV Management Services, L.P., Its general partner, By: SHV Management Services, LLC, Its general partner, By: Kevin Lalande, Its Managing Member, By: /s/ Jason S. Kim, Attorney in fact | 08/11/2017 | |
**Signature of Reporting Person | Date | |
SANTE HEALTH VENTURES I ANNEX FUND, L.P., By: SHV Annex Services, LP, Its general partner, By: SHV Management Services, LLC, Its general partner, By: Kevin Lalande, Its Managing Member, By: /s/ Jason S. Kim, Attorney in fact | 08/11/2017 | |
**Signature of Reporting Person | Date | |
JOE CUNNINGHAM, MD, By: /s/ Jason S. Kim, Attorney-in-Fact | 08/11/2017 | |
**Signature of Reporting Person | Date | |
DOUGLAS D. FRENCH, By: /s/ Jason S. Kim, Attorney in fact | 08/11/2017 | |
**Signature of Reporting Person | Date |
* | 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 securities held by Sante Health Ventures I, L.P. and Sante Health Ventures I Annex Fund, L.P. may be deemed to be beneficially owned by Joe Cunningham, M.D. and Douglas D. French, who are managing directors (the "SHV Directors") of SHV Management Services, LLC ("SHV Management"). SHV Management is the general partner of SHV Management Services, LP, which is the general partner of Sante Health Ventures I, L.P., and SHV Annex Services, LP, which is the general partner of Sante Health Ventures I Annex Fund, L.P. Each of the SHV Directors, SHV Management, SHV Management Services, LP and SHV Annex Services, LP disclaims beneficial ownership of the reported securities except to the extent of his or its pecuniary interest therein. |