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, 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. | 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 | ||||
Series B Preferred Stock | Â (1) | Â (1) | Common Stock | 2,627,257 | $ (1) | D (2) | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
InterWest Management Partners X, LLC 2710 SAND HILL ROAD, SUITE 200 MENLO PARK, CA 94025 |
 |  X |  |  |
Rosch Thomas L 2710 SAND HILL ROAD, SUITE 200 MENLO PARK, CA 94025 |
 |  X |  |  |
Desai Keval 2710 SAND HILL ROAD, SUITE 200 MENLO PARK, CA 94025 |
 |  X |  |  |
NASR KHALED 2710 SAND HILL ROAD, SUITE 200 MENLO PARK, CA 94025 |
 |  X |  |  |
/s/ W. Stephen Holmes, Managing Director | 06/27/2012 | |
**Signature of Reporting Person | Date | |
/s/ Thomas L. Rosch by Karen A. Wilson Power of Attorney | 06/27/2012 | |
**Signature of Reporting Person | Date | |
/s/ Keval Desai by Karen A. Wilson Power of Attorney | 06/27/2012 | |
**Signature of Reporting Person | Date | |
/s/ Khaled A. Nasr by Karen A. Wilson Power of Attorney | 06/27/2012 | |
**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 reported securities are convertible at any time, in whole or in part, at the option of the holder, have no expiration date, and will convert into shares of common stock immediately prior to the closing of the Issuer's initial public offering. |
(2) | The shares are owned by InterWest Partners X, LP ("IW10"). InterWest Management Partners X, LLC ("IMP10") is the general partner of IW10. Harvey B. Cash, Bruce A. Cleveland, Christopher B. Ehrlich, Philip T. Gianos, W. Stephen Holmes, Nina S. Kjellson, Gilbert H. Kliman, Arnold L. Oronsky, Douglas A. Pepper and Thomas L. Rosch are managing directors of IMP10. Keval Desai and Khaled A. Nasr are venture members of IMP10. Each managing director and venture member of IMP10 disclaims beneficial ownership of such shares, except to the extent of their pecuniary interest therein. |
 Remarks: Due to limitations of the EDGAR software, this Form 3 is filed on behalf of InterWest Management Partners X, LLC and certain other Reporting Persons, and is being filed on two Forms 3 (Part I and Part II) (collectively, the ''InterWest Form 3''). This filing represents Part II of the InterWest Form 3 and should be read together with Part I. Part I and Part II of the InterWest Form 3 shall constitute one filing. Exhibit List Exhibit 24.1- Power of Attorney of Thomas L. Rosch Exhibit 24.2- Power of Attorney of Keval Desai Exhibit 24.3- Power of Attorney of Khaled A. Nasr Exhibit 99 - Form 3 Joint Filer Information |