UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 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. | SEC 1473 (7-02) | ||
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. |
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) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Braeburn Pharmaceuticals BVBA SPRL BRUGMANNLAAN 147 VORST, C9 1190 |
X | |||
Apple Tree Consolidated BVBA SPRL BRUGMANNLAAN 147 VORST, C9 1190 |
X | |||
Apple Tree Investments S.a.r.l 1 BOULEVARD DE LA FOIRE N4 L-1528 |
X | |||
Apple Tree Partners IV, L.P. 47 HULFISH STREET, SUITE 441 PRINCETON, NJ 08542 |
X | |||
ATP III GP, Ltd. 47 HULFISH STREET, SUITE 441 PRINCETON, NJ 08542 |
X | |||
Harrison Seth Loring 47 HULFISH STREET, SUITE 441 PRINCETON, NJ 08542 |
X |
/s/ Lauren Farrell, as attorney-in-fact for Seth L. Harrison, Manager of Braeburn Pharmaceuticals BVBA SPRL | 12/04/2013 | |
**Signature of Reporting Person | Date | |
/s/ Lauren Farrell, as attorney-in-fact for Seth L. Harrison, Manager of Apple Tree Consolidated BVBA SPRL | 12/04/2013 | |
**Signature of Reporting Person | Date | |
/s/ Lauren Farrell, as attorney-in-fact for Seth L. Harrison, Manager of Apple Tree Investments S.a.r.l | 12/04/2013 | |
**Signature of Reporting Person | Date | |
/s/ Lauren Farrell, as attorney-in-fact for Seth L. Harrison, Manager of Braeburn Pharmaceuticals BVBA SPRL | 12/04/2013 | |
**Signature of Reporting Person | Date | |
/s/ Lauren Farrell, as attorney-in-fact for Seth L. Harrison, Director of ATP III GP, Ltd, general partner of Apple Tree Partners IV, L.P. | 12/04/2013 | |
**Signature of Reporting Person | Date | |
/s/ Lauren Farrell, as attorney-in-fact for Seth L. Harrison, Director of ATP III GP, Ltd. | 12/04/2013 | |
**Signature of Reporting Person | Date | |
/s/ Lauren Farrell, as attorney-in-fact for Seth L. Harrison | 12/04/2013 | |
**Signature of Reporting Person | Date |
* | 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) | Braeburn Pharmaceuticals BVBA SPRL ("Braeburn") is the record owner of the Shares. As the sole owner of Braeburn, Apple Tree Consolidated BVBA SPRL ("ATC") may be deemed to own beneficially the Shares. As the sole owner of ATC, Apple Tree Investments S.a.r.l ("ATI") may be deemed to own beneficially the Shares. As the sole owner of ATI, Apple Tree Partners IV, L.P. ("ATP IV") may be deemed to own beneficially the Shares. As the sole general partner of ATP IV, ATP III GP, Ltd. ("ATP GP") may be deemed to own beneficially the Shares. As the sole owner and director of ATP GP, Seth L. Harrison may be deemed to own beneficially the Shares. Each of the Reporting Persons, except Braeburn, disclaims beneficial ownership of the Shares except to the extent of their pecuniary interest therein, if any. |