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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-2 Preferred Stock | (8) | 02/11/2014 | C | 148,950 (3) | (8) | (8) | Common Stock | 148,950 (3) (8) | $ 0 | 0 | D (1) (3) | ||||
Series B Preferred Stock | (9) | 02/11/2014 | C | 83,377 (3) | (9) | (9) | Common Stock | 83,377 (3) (9) | $ 0 | 0 | D (1) (3) | ||||
Series B-1 Preferred Stock | (10) | 02/11/2014 | C | 44,207 (3) | (10) | (10) | Common Stock | 44,207 (3) (10) | $ 0 | 0 | D (1) (3) | ||||
Warrants | $ 0.001 | 02/11/2014 | X | 23,284 (3) | (11) | (11) | Common Stock | 23,284 (3) | $ 0 | 0 | D (1) (3) | ||||
Subordinated Convertible Debt | $ 6 | 02/11/2014 | C | $ 169,452 (3) | (12) | (12) | Common Stock | 28,242 (3) | $ 0 | 0 | D (1) (3) | ||||
Senior Convertible Debt | $ 6 | 02/11/2014 | C | $ 398,711 (3) | (13) | (13) | Common Stock | 66,450 (3) | $ 0 | 0 | D (1) (3) | ||||
Series A-2 Preferred Stock | (8) | 02/11/2014 | C | 302,576 (4) | (8) | (8) | Common Stock | 302,576 (4) (8) | $ 0 | 0 | D (1) (4) | ||||
Series B Preferred Stock | (9) | 02/11/2014 | C | 169,372 (4) | (9) | (9) | Common Stock | 169,372 (4) (9) | $ 0 | 0 | D (1) (4) | ||||
Series B-1 Preferred Stock | (10) | 02/11/2014 | C | 89,800 (4) | (10) | (10) | Common Stock | 89,800 (4) | $ 0 | 0 | D (1) (4) | ||||
Warrants | $ 0.001 | 02/11/2014 | X | 47,298 (4) | (11) | (11) | Common Stock | 47,298 (4) | $ 0 | 0 | D (1) (4) | ||||
Subordinated Convertible Debt | $ 6 | 02/11/2014 | C | $ 344,224 (4) | (12) | (12) | Common Stock | 57,370 (4) | $ 0 | 0 | D (1) (4) | ||||
Senior Convertible Debt | $ 6 | 02/11/2014 | C | $ 809,939 (4) | (13) | (13) | Common Stock | 134,988 (4) | $ 0 | 0 | D (1) (4) | ||||
Series A-2 Preferred Stock | (8) | 02/11/2014 | C | 5,390 (5) | (8) | (8) | Common Stock | 5,390 (5) (8) | $ 0 | 0 | D (1) (5) | ||||
Series B Preferred Stock | (9) | 02/11/2014 | C | 3,017 (5) | (9) | (9) | Common Stock | 3,017 (5) (9) | $ 0 | 0 | D (1) (5) | ||||
Series B-1 Preferred Stock | $ 10 | 02/11/2014 | C | 1,600 (5) | (10) | (10) | Common Stock | 1,600 (5) (10) | $ 0 | 0 | D (1) (5) | ||||
Warrants | $ 0.001 | 02/11/2014 | X | 842 (5) | (11) | (11) | Common Stock | 842 (5) | $ 0 | 0 | D (1) (5) | ||||
Subordinated Convertible Debt | $ 6 | 02/11/2014 | C | $ 6,132 (5) | (12) | (12) | Common Stock | 1,021 (5) | $ 0 | 0 | D (1) (5) | ||||
Senior Convertible Debt | $ 6 | 02/11/2014 | C | $ 14,427 (5) | (13) | (13) | Common Stock | 2,403 (5) | $ 0 | 0 | D (1) (5) | ||||
Series A-2 Preferred Stock | (8) | 02/11/2014 | C | 3,685 (6) | (8) | (8) | Common Stock | 3,685 (6) (8) | $ 0 | 0 | D (1) (6) | ||||
Series B Preferred Stock | (9) | 02/11/2014 | C | 2,062 (6) | (9) | (9) | Common Stock | 2,062 (6) (9) | $ 0 | 0 | D (1) (6) | ||||
Series B-1 Preferred Stock | (10) | 02/11/2014 | C | 1,093 (6) | (10) | (10) | Common Stock | 1,093 (6) (10) | $ 0 | 0 | D (1) (6) | ||||
Warrants | $ 0.001 | 02/11/2014 | X | 3,500 (6) | (11) | (11) | Common Stock | 3,500 (6) | $ 0 | 0 | D (1) (6) | ||||
Subordinated Convertible Debt | $ 6 | 02/11/2014 | C | $ 4,192 (6) | (12) | (12) | Common Stock | 698 (6) | $ 0 | 0 | D (1) (6) | ||||
Senior Convertible Debt | $ 6 | 02/11/2014 | C | $ 59,953 (6) | (13) | (13) | Common Stock | 9,991 (6) | $ 0 | 0 | D (1) (6) | ||||
Warrants | $ 0.001 | 02/11/2014 | X | 192,076 (7) | (11) | (11) | Common Stock | 192,076 (7) | $ 0 | 0 | D (1) (7) | ||||
Senior Convertible Debt | $ 6 | 02/11/2014 | C | $ 3,289,131 (7) | (13) | (13) | Common Stock | 548,186 (7) | $ 0 | 0 | D (1) (7) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Index Venture Associates III Ltd NO. 1 SEATON PLACE ST. HELIER, Y9 JE4 8YJ |
X | |||
Index Ventures III (Jersey) L.P. NO. 1 SEATON PLACE ST. HELIER, Y9 JE4 8YJ |
X | |||
Index Ventures III (Delaware) L.P. NO. 1 SEATON PLACE ST. HELIER, Y9 JE4 8YJ |
X | |||
Index Ventures III Parallel Entrepreneur Fund (Jersey) L.P. NO. 1 SEATON PLACE ST. HELIER, Y9 JE4 8YJ |
X | |||
Yucca (Jersey) SLP NO. 1 SEATON PLACE ST. HELIER, Y9 JE4 8YJ |
X | |||
INDEX VENTURES LIFE VI (JERSEY) L.P. NO. 1 SEATON PLACE ST. HELIER, Y9 JE4 8YJ |
X |
By: Stan Musial, Attorney in fact for Index Venture Associates III Ltd. | 02/13/2014 | |
**Signature of Reporting Person | Date | |
By: Stan Musial, Attorney in fact for Index Ventures III (Jersey), L.P. | 02/13/2014 | |
**Signature of Reporting Person | Date | |
By: Stan Musial, Attorney in fact for Index Ventures III (Delaware), L.P. | 02/13/2014 | |
**Signature of Reporting Person | Date | |
By: Stan Musial, Attorney in fact for Index Ventures III Parallel Entrepreneur Fund (Jersey) | 02/13/2014 | |
**Signature of Reporting Person | Date | |
By: Stan Musial, Attorney in fact for Yucca (Jersey) SLP | 02/13/2014 | |
**Signature of Reporting Person | Date | |
By: Stan Musial, Attorney in fact for Index Ventures Life VI (Jersey) L.P. | 02/13/2014 | |
**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) | These securities are owned, as indicated, by Index Ventures III (Jersey), L.P. ("Jersey"), Index Ventures III (Delaware), L.P. ("Delaware"), or Index Ventures III Parallel Entrepreneur Fund (Jersey) L.P. ("Index PEF"), of which Index Venture Associates III Ltd. ("Index Associates") is the general partner, or Yucca (Jersey) SLP ("Yucca") or Index Ventures Life VI (Jersey) L.P. ("Index VI"), of which Index Associates is an affiliate. Index Associates, Jersey, Delaware, Index PEF, Yucca and Index VI (collectively, the "Index Entities") are members of a "group" for purposes of Section 13(d) of the Exchange Act. This Form 4 is being filed jointly by the Index Entities in connection with the consummation of Egalet Corporation's initial public offering. Each of the Index Entities disclaims beneficial ownership of the securities held of record by any of the other Index Entities, except, in each case, to the extent of their respective proportionate pecuniary interest(s) therein. |
(2) | The reporting person is Egalet A/S, a corporation. Jersey, Delaware, Index PEF and Yucca are 6.90%, 14.03%, 0.25% and 0.20% equityholders of Egalet A/S, respectively. |
(3) | These securities are owned by Jersey. |
(4) | These securities are owned by Delaware. |
(5) | These securities are owned by Index PEF. |
(6) | These securities are owned by Yucca |
(7) | These securities are owned by Index VI. |
(8) | The Series A-2 Preferred Stock automatically converted into Egalet Corporation common stock on a 1-for-1 basis immediately prior to the consummation of Egalet Corporation's initial public offering. |
(9) | The Series B Preferred Stock automatically converted into Egalet Corporation common stock on a 1-for-1 basis immediately prior to the consummation of Egalet Corporation's initial public offering. |
(10) | The Series B-1 Preferred Stock automatically converted into Egalet Corporation common stock on a 1-for-1 basis immediately prior to the consummation of Egalet Corporation's initial public offering. |
(11) | The warrants were automatically exercised into Egalet Corporation common stock immediately prior to the consummation of the Egalet Corporation's initial public offering on a 1-for-1 basis, pursuant to the securityholders' purchase of a specified minimum amount of common stock in such offering. |
(12) | The subordinated convertible debt automatically converted into Egalet Corporation common stock immediately prior to the consummation of Egalet Corporation's initial public offering, based on a conversion price equal to 50% of the per share price in such offering, which was $12 per share. |
(13) | The senior convertible debt automatically converted into Egalet Corporation common stock immediately prior to the consummation of Egalet Corporation's initial public offering, based on a conversion price equal to 50% of the per share price in such offering, which was $12 per share. |