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-1 Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
2,064,781
(5)
|
$
(1)
|
I
|
By Domain Partners VII, L.P.
(6)
|
Series B Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
1,232,861
(5)
|
$
(1)
|
I
|
By Domain Partners VII, L.P.
(6)
|
Convertible Promissory Notes
|
Â
(2)
|
Â
(2)
|
Common Stock
|
873,800
(3)
(5)
|
$
(2)
|
I
|
By Domain Partners VII, L.P.
(6)
|
Warrants
|
Â
(4)
|
Â
(4)
|
Series B Preferred Stock
(1)
|
168,677
(4)
(5)
|
$
11
|
I
|
By Domain Partners VII, L.P.
(6)
|
Series A-1 Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
35,215
(5)
|
$
(1)
|
I
|
By DP VII Associates, L.P.
(6)
|
Series B Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
21,027
(5)
|
$
(1)
|
I
|
By DP VII Associates, L.P.
(6)
|
Convertible Promissory Notes
|
Â
(2)
|
Â
(2)
|
Common Stock
|
14,903
(3)
(5)
|
$
(2)
|
I
|
By DP VII Associates, L.P.
(6)
|
Warrants
|
Â
(4)
|
Â
(4)
|
Series B Preferred Stock
(1)
|
2,874
(4)
(5)
|
$
11
|
I
|
By DP VII Associates, L.P.
(6)
|
Series A-1 Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
9,894
(5)
|
$
(1)
|
I
(1)
|
By Domain Partners VI, L.P.
(6)
|
Series A-1 Preferred Stock
|
Â
(1)
|
Â
(1)
|
Common Stock
|
106
(5)
|
$
(1)
|
I
(1)
|
By DP VI Associates, L.P.
(6)
|
* |
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) |
All outstanding shares of the Issuer's preferred stock will automatically convert into Common Stock upon the closing of the Issuer's initial public offering (the "IPO"), for no additional consideration. |
(2) |
All Convertible Promissory Notes, plus interest accrued thereon, will automatically convert into Common Stock upon the closing of the IPO, at the IPO price. |
(3) |
Assumes IPO price of $4.00 per share of Common Stock and IPO closing on or about November 29, 2010. |
(4) |
Warrants are fully exercisable and will expire if not exercised in the IPO. If exercised upon closing of the IPO the Warrants will be net exercised, and therefore the number of shares of Common Stock issued to the Warrant holder will be adjusted in accordance with such net exercise. |
(5) |
Share numbers reflect the 1-for-10 reverse split of the Common Stock effective immediately prior to the IPO. |
(6) |
The Reporting Person is a Managing Member of (i) One Palmer Square Associates VII, LLC, which is the sole general partner of Domain Partners VII, L.P. and DP VII Associates, L.P., (ii) One Palmer Square Associates VI, LLC, which is the sole general partner of Domain Partners VI, L.P. and DP VI Associates, L.P., and (iii) Domain Associates, LLC. Pursuant to Instruction (5)(b)(iv) of Form 3, the Reporting Person has elected to report as indirectly beneficially owned the entire number of securities beneficially owned by each such entity. The Reporting Person disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his or her pecuniary interest therein and/or that are not actually distributed to him or her. |