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-2 Preferred Stock
|
(4)
|
(4)
|
Common Stock
|
271
|
$
(4)
|
D
|
|
Series B-1 Preferred Stock
|
(5)
|
(5)
|
Common Stock
|
458
|
$
(4)
|
D
|
|
Warrant (Right to Buy)
|
(6)
|
08/03/2019 |
Series B-1 Preferred Stock
|
48
|
$
5.8667
|
D
|
|
Stock Option (Right to Buy)
|
(7)
|
02/02/2026 |
Common Stock
|
11,765
|
$
0.85
|
D
|
|
Series A-2 Preferred Stock
|
(4)
|
(4)
|
Common Stock
|
11,694
|
$
(4)
|
I
|
By Trust
(1)
|
Series B-1 Preferred Stock
|
(5)
|
(5)
|
Common Stock
|
13,764
|
$
(5)
|
I
|
By Trust
(2)
|
Warrant (Right to Buy)
|
(6)
|
08/31/2019 |
Series B-1 Preferred Stock
|
1,800
|
$
5.8667
|
I
|
By Trust
(1)
|
Series A-2 Preferred Stock
|
(4)
|
(4)
|
Common Stock
|
1,123
|
$
(4)
|
I
|
By Trust
(2)
|
Series B-1 Preferred Stock
|
(5)
|
(5)
|
Common Stock
|
10,110
|
$
(5)
|
I
|
By Trust
(2)
|
Warrant (Right to Buy)
|
(6)
|
08/31/2019 |
Series B-1 Preferred Stock
|
785
|
$
5.8667
|
I
|
By Trust
(2)
|
Series A-2 Preferred Stock
|
(4)
|
(4)
|
Common Stock
|
1,600
|
$
(4)
|
I
|
By Limited Liability Company
(3)
|
Series B-1 Preferred Stock
|
(5)
|
(5)
|
Common Stock
|
2,473
|
$
(5)
|
I
|
By Limited Liability Company
|
Warrant (Right to Buy)
|
(6)
|
07/12/2019 |
Series B-1 Preferred Stock
|
262
|
$
5.8667
|
I
|
By Limited Liability Company
|
* |
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 are held directly by Pascal Levensohn Revocable Trust, over which Reporting Person holds voting and dispositive power. |
(2) |
Shares are held directly by Levensohn 2000 Children's Trust, over which Reporting Person holds voting and dispositive power. |
(3) |
Shares are held directly by Levensohn Securities Holdings, LLC, over which Reporting Person holds voting and dispositive power. |
(4) |
Each share of Series A-2 Preferred Stock will be automatically converted into 0.715548 shares of Common Stock upon the closing of the Issuer's initial public offering of Common Stock and has no expiration date. |
(5) |
Each share of Series B-1 Preferred Stock will be automatically converted into 1 share of Common Stock upon the closing of the Issuer's initial public offering of Common Stock and has no expiration date. |
(6) |
Immediate. |
(7) |
1/48th of the grant vests monthly for 48 months from February 1, 2016. |