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 E Convertible Preferred Stock
|
Â
(4)
|
Â
(4)
|
Common Stock
|
31,250
|
$
(4)
|
I
|
See footnote.
(5)
|
Series E Convertible Preferred Stock
|
Â
(4)
|
Â
(4)
|
Common Stock
|
31,250
|
$
(4)
|
I
|
See footnote.
(6)
|
Series E Convertible Preferred Stock
|
Â
(4)
|
Â
(4)
|
Common Stock
|
62,500
|
$
(4)
|
I
|
See footnote.
(7)
|
Employee stock option (right to buy)
|
Â
(8)
|
08/08/2016 |
Common Stock
|
100,000
|
$
2
|
D
|
Â
|
* |
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 held directly by the Thomas J. Fallon 2006 Annuity Trust A dated 6/9/06 for which the Reporting Person serves as trustee. |
(2) |
Shares held directly by the Shannon F. Fallon 2006 Annuity Trust A dated 6/9/06 for which the Reporting Person serves as trustee. |
(3) |
Shares held directly by the Fallon Family Revocable Trust dated 9/7/94 for which the Reporting Person serves as a trustee. |
(4) |
The Series E Convertible Preferred Stock shall automatically convert into Common Stock on a one-for-one basis immediately prior to the closing of the Issuer's initial public offering of common stock. |
(5) |
Shares held directly by the Thomas J. Fallon 2006 Annuity Trust dated 5/2/06 for which the Reporting Person serves as trustee. |
(6) |
Shares held directly by the Shannon F. Fallon 2006 Annuity Trust dated 5/2/06 for which the Reporting Person serves as trustee. |
(7) |
Shares held directly by the Fallon Family Heritage Trust dated May 2, 2006 for which the Reporting Person serves as a trustee. |
(8) |
The option is subject to an early exercise provision and is immediately exercisable. One forty-eighth of the shares subject to the option vested on July 29, 2006 and one forty-eighth of the shares shall vest monthly thereafter. |