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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 A-1 Convertible Preferred Stock | (1) | 11/29/2010 | C | 11,527,800 | (1) | (1) | Common Stock | 1,152,780 | (1) | 0 | D (2) (9) (10) | ||||
Series B Convertible Preferred Stock | (1) | 11/29/2010 | C | 2,071,593 | (1) | (1) | Common Stock | 207,159 | (1) | 0 | D (2) (9) (10) | ||||
8% Convertible Promissory Note | (3) | 11/29/2010 | C(3) | 129,855 | (3) | (3) | Common Stock | 129,855 | (3) | 0 | D (2) (9) (10) | ||||
Series A-1 Convertible Preferred Stock | (1) | 11/29/2010 | C | 428,400 | (1) | (1) | Common Stock | 42,840 | (1) | 0 | I (4) (9) (10) | By TMP Nominee, LLC | |||
Series B Convertible Preferred Stock | (1) | 11/29/2010 | C | 76,975 | (1) | (1) | Common Stock | 7,697 | (1) | 0 | I (4) (9) (10) | By TMP Nominee, LLC | |||
8% Convertible Promissory Note | (3) | 11/29/2010 | C(3) | 2,379 | (3) | (3) | Common Stock | 2,379 | (3) | 0 | I (4) (9) (10) | By TMP Nominee, LLC | |||
Series A-1 Convertible Preferred Stock | (1) | 11/29/2010 | C | 43,800 | (1) | (1) | Common Stock | 4,380 | (1) | 0 | I (5) (9) (10) | By TMP Associates, L.P. | |||
Series B Convertible Preferred Stock | (1) | 11/29/2010 | C | 7,869 | (1) | (1) | Common Stock | 786 | (1) | 0 | I (5) (9) (10) | By TMP Associates, L.P. | |||
8% Convertible Promissory Note | (3) | 11/29/2010 | C(3) | 484 | (3) | (3) | Common Stock | 484 | (3) | 0 | I (5) (9) (10) | By TMP Associates, L.P. |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
THOMAS MCNERNEY & PARTNERS LP 60 SOUTH 6TH STREET SUITE 3620 MINNEAPOLIS, MN 55402 |
See Footnote (10) | |||
Thomas, McNerney & Partners, LLC 60 SOUTH 6TH STREET SUITE 3620 MINNEAPOLIS, MN 55402 |
See Footnote (10) | |||
TMP Nominee, LLC 60 SOUTH 6TH STREET SUITE 3620 MINNEAPOLIS, MN 55402 |
See Footnote (10) | |||
TMP ASSOCIATES LP 60 SOUTH 6TH STREET SUITE 3620 MINNEAPOLIS, MN 55402 |
See Footnote (10) | |||
Thomas, McNerney & Partners II L.P. 60 SOUTH 6TH STREET SUITE 3620 MINNEAPOLIS, MN 55402 |
See Footnote (10) | |||
Thomas, McNerney & Partners II, LLC 60 SOUTH 6TH STREET SUITE 3620 MINNEAPOLIS, MN 55402 |
See Footnote (10) | |||
TMP Nominee II, LLC 60 SOUTH 6TH STREET SUITE 3620 MINNEAPOLIS, MN 55402 |
See Footnote (10) | |||
TMP Associates II LP 60 SOUTH 6TH STREET SUITE 3620 MINNEAPOLIS, MN 55402 |
See Footnote (10) | |||
THOMAS JAMES E 60 SOUTH 6TH STREET SUITE 3620 MINNEAPOLIS, MN 55402 |
See Footnote (10) | |||
McNerney Pete 60 SOUTH 6TH STREET SUITE 3620 MINNEAPOLIS, MN 55402 |
See Footnote (10) |
/s/ James E. Thomas, Manager of Thomas, McNerney & Partners, LLC, the general partner of Thomas, McNerney & Partners, L.P. | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ James E. Thomas, Manager of Thomas, McNerney & Partners, LLC | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ James E. Thomas, Manager of TMP Nominee, LLC | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ James E. Thomas, Manager of Thomas, McNerney & Partners, LLC, the general partner of TMP Associates, L.P. | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ James E. Thomas, Manager of Thomas, McNerney & Partners II, LLC, the general partner of Thomas, McNerney & Partners II, L.P. | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ James E. Thomas, Manager of Thomas, McNerney & Partners II, LLC | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ James E. Thomas, Manager of TMP Nominee II, LLC | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ James E. Thomas, Manager of Thomas, McNerney & Partners II, LLC, the general partner of TMP Associates II, L.P. | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ James E. Thomas | 11/29/2010 | |
**Signature of Reporting Person | Date | |
/s/ Peter H. McNerney | 11/29/2010 | |
**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 A-1 Convertible Preferred Stock and the Series B Convertible Preferred Stock automatically converted to Common Stock at the closing of the Issuer's initial public offering on November 29, 2010 at a conversion ratio one share of Common Stock for every ten shares of Series A-1 Convertible Preferred Stock and one share of Common Stock for every ten shares of Series B Convertible Preferred Stock, as applicable, rounded down to the next whole number, for no additional consideration. |
(2) | These securities are owned of record by Thomas, McNerney & Partners, L.P. ("TMP LP"). Thomas, McNerney & Partners, LLC ("TMP LLC") is the general partner of TMP LP and has shared voting and dispositive power of the securities held by TMP LP, but TMP LLC disclaims beneficial ownership of such securities except to the extent of its pecuniary interest therein. The managers of TMP LLC having shared voting and dispositive power over these securities are James E. Thomas and Peter H. McNerney, each of whom disclaims beneficial ownership of such shares except to the extent of their pecuniary interest therein. |
(3) | The principle of the Note and accrued interest thereon was automatically converted upon the closing of the Issuer's initial public offering on November 29, 2010 into shares of Common Stock at a conversion price equal to $4.00 per share, the per share price of the Common Stock sold in the Issuer's initial public offering. |
(4) | These securities are owned of record by TMP Nominee, LLC ("TMP Nominee"). The managers of TMP Nominee having shared voting and dispositive power over these securities are James E. Thomas and Peter H. McNerney, each of whom disclaims beneficial ownership of such shares except to the extent of their pecuniary interest therein. |
(5) | These securities are owned of record by TMP Associates, L.P. ("TMP Associates"). TMP LLC is the general partner of TMP Associates and has shared voting and dispositive power of the securities held by TMP Associates, but TMP LLC disclaims beneficial ownership of such securities except to the extent of its pecuniary interest therein. The managers of TMP LLC having shared voting and dispositive power over these securities are James E. Thomas and Peter H. McNerney, each of whom disclaims beneficial ownership of such shares except to the extent of their pecuniary interest therein. |
(9) | The filing of this statement shall not be deemed an admission that, for the purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, the Reporting Persons are the beneficial owners of equity securities covered by this statement. |
(10) | Upon the closing of the Issuer's initial public offering on November 29, 2010, the Reporting Persons ceased to be 10% owners of the Issuer's securities. |
Remarks: Because of the limitations on the number of line-item holdings that can be filed on any one Form 4 through the SEC's EDGAR system, the reporting persons have filed two (2) Form 4's with respect to Zogenix, Inc. on the date hereof, which, taken together, constitute one Form 4. The Reporting Person named in Box 1 of these three Form 4's is Thomas, McNerney & Partners, L.P. This Form 4 is filed as Part 1 of 2 parts. |