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-3 Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
1,190,203
|
$
(3)
|
I
|
Walnut Capital Partners, L.P.
(1)
|
Series B-2 Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
1,380,418
|
$
(4)
|
I
|
Walnut Capital Partners, L.P.
(1)
|
Series D-1 Convertible Preferred Stock
|
Â
(2)
|
Â
(2)
|
Common Stock
|
813,499
|
$
(5)
|
I
|
Walnut Investment Partners, L.P.
(6)
|
* |
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) |
James Gould is a manager of Walnut Capital Management Group, LLC which is the general partner of Walnut Capital Partners,
L.P. Mr. Gould disclaims beneficial ownership of the shares owned by Walnut Capital Partners, L.P. except to the extent of
his pecuniary interest therein. |
(2) |
Convertible upon demand. All shares of preferred stock will convert automatically upon consummation of the Company's initial
public offering. |
(3) |
1.30333-to-1. |
(4) |
1-to-1. |
(5) |
1.200083-to-1. |
(6) |
James Gould is a manager of Walnut Investments Holding Company which is the general partner of Walnut Investment Partners,
L.P. Mr. Gould disclaims beneficial ownership of the shares owned by Walnut Investment Partners, L.P. except to the extent
of his pecuniary interest therein. |