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
|
04/15/2002 |
Â
(3)
|
Common Stock
|
83,278
(3)
|
$
0
(3)
|
I
|
CHL Medical Partners II, L.P.
(1)
|
Series A Convertible Preferred Stock
|
04/15/2002 |
Â
(3)
|
Common Stock
|
5,611
(3)
|
$
0
(3)
|
I
|
CHL Medical Partners II Side Fund, L.P.
(2)
|
Series A Convertible Preferred Stock
|
07/15/2002 |
Â
(3)
|
Common Stock
|
333,111
|
$
0
(3)
|
I
|
CHL Medical Partners II, L.P.
|
Series A Convertible Preferred Stock
|
07/15/2002 |
Â
(3)
|
Common Stock
|
22,444
|
$
0
(3)
|
I
|
CHL Medical Partners II Side Fund, L.P.
|
Series B Convertible Preferred Stock
|
05/04/2005 |
Â
(3)
|
Common Stock
|
734,803
(3)
|
$
0
(3)
|
I
|
CHL Medical Partners II, L.P.
(1)
|
Series B Convertible Preferred Stock
|
05/04/2005 |
Â
(3)
|
Common Stock
|
49,509
(3)
|
$
0
(3)
|
I
|
CHL Medical Partners II Side Fund, L.P.
(2)
|
Series B Convertible Preferred Stock
|
04/18/2006 |
Â
(3)
|
Common Stock
|
11,182
(3)
|
$
0
(3)
|
I
|
CHL Medical Partners II, L.P.
(1)
|
Series B Convertible Preferred Stock
|
04/18/2006 |
Â
(3)
|
Common Stock
|
753
(3)
|
$
0
(3)
|
I
|
CHL Medical Partners II Side Fund, L.P.
(2)
|
Series C Convertible Preferred Stock
|
08/16/2005 |
Â
(3)
|
Common Stock
|
247,850
(3)
|
$
0
(3)
|
I
|
CHL Medical Partners II, L.P.
(1)
|
Series C Convertible Preferred Stock
|
08/16/2005 |
Â
(3)
|
Common Stock
|
16,699
(3)
|
$
0
(3)
|
I
|
CHL Medical Partners II Side Fund, L.P.
(2)
|
Series C Convertible Preferred Stock
|
04/17/2006 |
Â
(3)
|
Common Stock
|
247,850
(3)
|
$
0
(3)
|
I
|
CHL Medical Partners II, L.P.
(1)
|
Series C Convertible Preferred Stock
|
04/17/2006 |
Â
(3)
|
Common Stock
|
16,699
(3)
|
$
0
(3)
|
I
|
CHL Medical Partners II Side Fund, L.P.
(2)
|
Series D Convertible Preferred Stock
|
09/13/2006 |
Â
(3)
|
Common Stock
|
96,233
(3)
|
$
0
(3)
|
I
|
CHL Medical Partners II, L.P.
(1)
|
Series D Convertible Preferred Stock
|
09/13/2006 |
Â
(3)
|
Common Stock
|
6,484
(3)
|
$
0
(3)
|
I
|
CHL Medical Partners II Side Fund, L.P.
(2)
|
Series D Convertible Preferred Stock
|
03/09/2007 |
Â
(3)
|
Common Stock
|
96,233
(3)
|
$
0
(3)
|
I
|
CHL Medical Partners II, L.P.
(1)
|
Series D Convertible Preferred Stock
|
03/09/2007 |
Â
(3)
|
Common Stock
|
6,484
|
$
0
(3)
|
I
|
CHL Medical Partners II Side Fund, L.P.
|
* |
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 reporting person is a member of Collinson, Howe & Lennox II, LLC, which is the general partner of CHL Medical Partners II, L.P. Voting and investment power over these shares is exercised by Collinson, Howe & Lennox II, LLC in its role as general partner and investment advisor of CHL Medical Partners II, L.P. The reporting person disclaims beneficial ownership of these shares except to the extent of his proportionate pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of these shares for purposes of section 16 or for any other purpose. |
(2) |
The reporting person is a partner of Collinson, Howe & Lennox II, LLC, which is the general partner of CHL Medical Partners II Side Fund, L.P. Voting and investment power over these shares is exercised by Collinson, Howe & Lennox II, LLC in its role as general partner and investment advisor of CHL Medical Partners II Side Fund, L.P. The reporting person disclaims beneficial ownership of these shares except to the extent of his proportionate pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of these shares for purposes of section 16 or for any other purpose. |
(3) |
Each share is convertible and will automatically convert on a 1-for-1 basis into the Issuer's common stock upon the closing of the Issuer's initial public offering of common stock pursuant to an effecive registration statement filed with the U.S. Securities and Exchange Commission. These shares have no expiration date. |