SEC Form 3
| FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL 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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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 06/24/2015 | 3. Issuer Name and Ticker or Trading Symbol GLAUKOS Corp [ GKOS ] | |||||||||||||
| 4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Beneficially Owned | |||
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| 1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
| Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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| 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: 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 Convertible Preferred Stock | (1) | (1) | Common Stock | 552,000 | (1) | I | Through Versant Venture Capital I, L.P.(3) |
| Series A Convertible Preferred Stock | (1) | (1) | Common Stock | 12,000 | (1) | I | Through Versant Affiliates Fund I-A, L.P.(4) |
| Series A Convertible Preferred Stock | (1) | (1) | Common Stock | 25,200 | (1) | I | Through Versant Affiliates Fund I-B, L.P.(5) |
| Series A Convertible Preferred Stock | (1) | (1) | Common Stock | 10,800 | (1) | I | Through Versant Side Fund I, L.P.(6) |
| Series B Convertible Preferred Stock | (1) | (1) | Common Stock | 851,852 | (1) | I | Through Versant Venture Capital I, L.P.(3) |
| Series B Convertible Preferred Stock | (1) | (1) | Common Stock | 18,518 | (1) | I | Through Versant Affiliates Fund I-A, L.P.(4) |
| Series B Convertible Preferred Stock | (1) | (1) | Common Stock | 38,888 | (1) | I | Through Versant Affiliates Fund I-B, L.P.(5) |
| Series B Convertible Preferred Stock | (1) | (1) | Common Stock | 16,666 | (1) | I | Through Versant Side Fund I, L.P.(6) |
| Series C Convertible Preferred Stock | (1) | (1) | Common Stock | 479,714 | (1) | I | Through Versant Venture Capital I, L.P.(3) |
| Series C Convertible Preferred Stock | (1) | (1) | Common Stock | 10,428 | (1) | I | Through Versant Affiliates Fund I-A, L.P.(4) |
| Series C Convertible Preferred Stock | (1) | (1) | Common Stock | 21,900 | (1) | I | Through Versant Affiliates Fund I-B, L.P.(5) |
| Series C Convertible Preferred Stock | (1) | (1) | Common Stock | 9,386 | (1) | I | Through Versant Side Fund I, L.P.(6) |
| Series D Convertible Preferred Stock | (1) | (1) | Common Stock | 548,464 | (1) | I | Through Versant Venture Capital I, L.P.(3) |
| Series D Convertible Preferred Stock | (1) | (1) | Common Stock | 11,805 | (1) | I | Through Versant Affiliates Fund I-A, L.P.(4) |
| Series D Convertible Preferred Stock | (1) | (1) | Common Stock | 25,226 | (1) | I | Through Versant Affiliates Fund I-B, L.P.(5) |
| Series D Convertible Preferred Stock | (1) | (1) | Common Stock | 10,791 | (1) | I | Through Versant Side Fund I, L.P.(6) |
| Series E Convertible Preferred Stock | (1) | (1) | Common Stock | 163,592 | (1) | I | Through Versant Venture Capital I, L.P.(3) |
| Series E Convertible Preferred Stock | (1) | (1) | Common Stock | 3,420 | (1) | I | Through Versant Affiliates Fund I-A, L.P.(4) |
| Series E Convertible Preferred Stock | (1) | (1) | Common Stock | 7,684 | (1) | I | Through Versant Affiliates Fund I-B, L.P.(5) |
| Series E Convertible Preferred Stock | (1) | (1) | Common Stock | 3,271 | (1) | I | Through Versant Side Fund I, L.P.(6) |
| Series F Convertible Preferred Stock | (1) | (1) | Common Stock | 273,337 | (1) | I | Through Versant Venture Capital I, L.P.(3) |
| Series F Convertible Preferred Stock | (1) | (1) | Common Stock | 5,715 | (1) | I | Through Versant Affiliates Fund I-A, L.P.(4) |
| Series F Convertible Preferred Stock | (1) | (1) | Common Stock | 12,840 | (1) | I | Through Versant Affiliates Fund I-B, L.P.(5) |
| Series F Convertible Preferred Stock | (1) | (1) | Common Stock | 5,465 | (1) | I | Through Versant Side Fund I, L.P.(6) |
| Series D Convertible Preferred Stock Warrant (right to buy) | (2) | (2) | Common Stock | 27,612 | (2) | I | Through Versant Venture Capital I, L.P.(3) |
| Series D Convertible Preferred Stock Warrant (right to buy) | (2) | (2) | Common Stock | 577 | (2) | I | Through Versant Affiliates Fund I-A, L.P.(4) |
| Series D Convertible Preferred Stock Warrant (right to buy) | (2) | (2) | Common Stock | 1,296 | (2) | I | Through Versant Affiliates Fund I-B, L.P.(5) |
| Series D Convertible Preferred Stock Warrant (right to buy) | (2) | (2) | Common Stock | 552 | (2) | I | Through Versant Side Fund I, L.P.(6) |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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| Explanation of Responses: |
| 1. The shares of Series A Convertible Preferred Stock, Series B Convertible Preferred Stock, Series C Convertible Preferred Stock, Series D Convertible Preferred Stock, Series E Convertible Preferred Stock and Series F Convertible Preferred Stock shall automatically convert into shares of common stock on a 1:1 basis immediately prior to the consummation of the Issuer's initial public offering ("IPO") and have no expiration date. |
| 2. The warrants to acquire Series D Convertible Preferred Stock shall automatically net exercise immediately prior to consummation of the IPO at the IPO price per share and the shares of Series D Convertible Preferred Stock received thereupon shall automatically convert into shares of common stock as described in footnote (1). |
| 3. The shares and warrants are held by Versant Venture Capital I, L.P., a Delaware limited partnership ("VVC I"). Versant Ventures I, LLC, a Delaware limited liability company ("VV I'') serves as the sole general partner of VVC I. Brian G. Atwood, Samuel D. Colella, Ross A. Jaffe, William J. Link, Ph.D., Donald B. Milder, Rebecca B. Robertson and Barbara N. Lubash are directors and/or members of VV I and share voting and dispositive power over the shares held by VVC I; however, they disclaim beneficial ownership of the shares held by such entities except to the extent of their pecuniary interests therein. William J. Link, Ph.D. is a director of the Issuer and, accordingly, files separate Section 16 reports. |
| 4. The shares and warrants are held by Versant Affiliates Fund I-A, L.P., a Delaware limited partnership ("VAF I-A''). VV I serves as the sole general partner of VAF I-A. Brian G. Atwood, Samuel D. Colella, Ross A. Jaffe, William J. Link, Ph.D., Donald B. Milder, Rebecca B. Robertson and Barbara N. Lubash are directors and/or members of VV I and share voting and dispositive power over the shares held by VAF I-A; however, they disclaim beneficial ownership of the shares held by such entities except to the extent of their pecuniary interests therein. William J. Link, Ph.D. is a director of the Issuer and, accordingly, files separate Section 16 reports. |
| 5. The shares and warrants are held by Versant Affiliates Fund I-B, L.P., a Delaware limited partnership ("VAF I-B''). VV I serves as the sole general partner of VAF I-B. Brian G. Atwood, Samuel D. Colella, Ross A. Jaffe, William J. Link, Ph.D., Donald B. Milder, Rebecca B. Robertson and Barbara N. Lubash are directors and/or members of VV I and share voting and dispositive power over the shares held by VAF I-B; however, they disclaim beneficial ownership of the shares held by such entities except to the extent of their pecuniary interests therein. William J. Link, Ph.D. is a director of the Issuer and, accordingly, files separate Section 16 reports. |
| 6. The shares and warrants are held by Versant Side Fund I, L.P., a Delaware limited partnership ("VSF I''). VV I serves as the sole general partner of VSF I. Brian G. Atwood, Samuel D. Colella, Ross A. Jaffe, William J. Link, Ph.D., Donald B. Milder, Rebecca B. Robertson and Barbara N. Lubash are directors and/or members of VV I and share voting and dispositive power over the shares held by VSF I; however, they disclaim beneficial ownership of the shares held by such entities except to the extent of their pecuniary interests therein. William J. Link, Ph.D. is a director of the Issuer and, accordingly, files separate Section 16 reports. |
| Remarks: |
| Form 1 of 2 |
| /s/ Robin L. Praeger, Attorney-in-Fact | 06/24/2015 | |
| ** Signature of Reporting Person | Date | |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
| * 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). | ||
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
| 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 Number. | ||