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 | ||||
Stock Options (right to buy) | (1) | 04/09/2024 | Common Stock | 478,245 | $ 0.26 | D | |
Warrants (right to buy) | 01/09/2014 | (2) | Common Stock | 6,982 | $ 0.5 | D | |
Warrants (right to buy) | 04/11/2014 | (3) | Common Stock | 797,075 | $ 0.26 | D | |
Series B Convertible Preferred Stock | (4) | (4) | Common Stock | 300,000 | $ (4) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Stern Jon Leland PO BOX 955 MILL VALLEY, CA 94942 |
X | Chief Executive Officer |
/s/ Jeffrey Biunno, Attorney-in-fact for Jon Stern | 12/19/2014 | |
**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) | Shares subject to the option shall vest in a series of 36 successive equal monthly installments commencing on May 1, 2013. |
(2) | The warrant expires on the earlier to occur of January 9, 2019 or certain liquidation events. |
(3) | The warrant expires on the earlier to occur of April 11, 2024 or certain liquidation events. |
(4) | The convertible preferred stock is convertible to common stock on a one-for-one basis at any time, at the holder's election, and automatically on completion of the issuer's initial public offering. |