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 Preferred Shares
|
(1)
|
(2)
|
Ordinary Shares
|
721,408
|
$
(1)
|
I
|
By Sofinnova Venture Partners IX, L.P.
(3)
|
Series B-1 Preferred Shares
|
(4)
|
(2)
|
Ordinary Shares
|
275,446
|
$
(4)
|
I
|
By Sofinnova Venture Partners IX, L.P.
(3)
|
Series B-2 Preferred Shares
|
(5)
|
(2)
|
Ordinary Shares
|
229,660
|
$
(5)
|
I
|
By Sofinnova Venture Partners IX, L.P.
(3)
|
* |
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 Series A Preferred Shares are convertible into Ordinary Shares of the Issuer at the option of the holder. The Series A Preferred Shares will automatically convert into Ordinary Shares of the Issuer on a 1-to-1 basis upon closing of the initial public offering of the Issuer. |
(2) |
Not applicable. |
(3) |
These shares are held directly by Sofinnova Venture Partners IX, L.P. (the "Fund"). The general partner of the Fund is Sofinnova Management IX, L.L.C. (the "GP") and may be deemed to have sole voting, investment and dispositive power with respect to the shares held by the Fund. The Reporting Person is one of the three managing members of the GP. The Reporting Person disclaims Section 16 beneficial ownership of the securities held by the Fund, except to the extent of his pecuniary interest therein, if any. |
(4) |
The Series B-1 Preferred Shares are convertible into Ordinary Shares of the Issuer at the option of the holder. The Series B-1 Preferred Shares will automatically convert into Ordinary Shares of the Issuer on a 1-to-1 basis upon closing of the initial public offering of the Issuer. |
(5) |
The Series B-2 Preferred Shares are convertible into Ordinary Shares of the Issuer at the option of the holder. The Series B-2 Preferred Shares will automatically convert into Ordinary Shares of the Issuer on a 1-to-1 basis upon closing of the initial public offering of the Issuer. |