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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series C Preferred Stock | (1) | 08/18/2014 | C | 3,445 | (1) | (1) | Common Stock | 3,445 | $ 0 | 0 | I | See footnote (2) | |||
Series D Preferred Stock | (1) | 08/18/2014 | C | 1,254 | (1) | (1) | Common Stock | 1,254 | $ 0 | 0 | I | See footnote (2) | |||
Series C Preferred Stock Warrant (right to buy) | $ 8.79 | 08/18/2014 | C | 113 (4) | (3) | 08/18/2014 | Series C Preferred Stock (1) | 113 | $ 0 | 0 | I | See footnote (2) | |||
Common Stock Warrant (right to buy) | $ 8.79 | 08/18/2014 | C | 113 (4) | (3) | 08/18/2014 | Common Stock | 113 | $ 0 | 113 | I | See footnote (2) | |||
Common Stock Warrant (right to buy) | $ 8.79 | 08/18/2014 | X | 113 | (3) | 08/18/2014 | Common Stock | 113 | $ 0 | 0 | I | See footnote (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Weber David Allen C/O OTONOMY, INC. 6275 NANCY RIDGE DRIVE SAN DIEGO, CA 92121 |
X | President & CEO |
/s/ Paul E. Cayer, by power of attorney | 08/18/2014 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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) | Each of the Series C Convertible Preferred Stock and Series D Convertible Preferred Stock automatically converted into Common Stock on a one to one basis immediately prior to the completion of the Issuer's initial public offering of common stock and had no expiration date. |
(2) | The reported shares are held directly by The Weber Trust Dated March 9, 2005 for which the Reporting Person serves as a trustee. |
(3) | The warrants are immediately exercisable. |
(4) | The Series C Preferred Stock Warrants automatically converted into Common Stock Warrants on a one to one basis immediately prior to the completion of the Issuer's initial public offering of common stock. |