SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol GLAUKOS Corp [ GKOS ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 06/30/2015 | ||||||||||||||||||||||||||
4. 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 Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 06/30/2015 | C | 2,603,362 | A | (1) | 2,603,362 | I | Through InterWest Partners IX, L.P.(2) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series C Convertible Preferred Stock | (1) | 06/30/2015 | C | 1,523,809 | (1) | (1) | Common Stock | 1,523,809 | $0(1) | 0 | I | Through InterWest Partners IX, L.P.(2) | |||
Series D Convertible Preferred Stock | (1) | 06/30/2015 | C | 674,510 | (1) | (1) | Common Stock | 674,510 | $0(1) | 0 | I | Through InterWest Partners IX, L.P.(2) | |||
Series E Convertible Preferred Stock | (1) | 06/30/2015 | C | 151,653 | (1) | (1) | Common Stock | 151,653 | $0(1) | 0 | I | Through InterWest Partners IX, L.P.(2) | |||
Series F Convertible Preferred Stock | (1) | 06/30/2015 | C | 253,390 | (1) | (1) | Common Stock | 253,390 | $0(1) | 0 | I | Through InterWest Partners IX, L.P.(2) |
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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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. The shares of Series C Convertible Preferred Stock, Series D Convertible Preferred Stock, Series E Convertible Preferred Stock and Series F Convertible Preferred Stock automatically converted into shares of common stock on a 1:1 basis immediately prior to the consummation of the Issuer's initial public offering and had no expiration date. |
2. Shares held by InterWest Partners IX, L.P., a California limited partnership ("IWP-9"). InterWest Management Partners IX, LLC, a California limited liability company ("IMP-9") serves as the sole general partner of IWP-9 and owns no shares directly. Philip T. Gianos, W. Stephen Holmes, Gilbert H. Kliman, M.D. and Arnold L. Oronsky are the managing directors of IMP-9. Bruce A. Cleveland, Nina Kjellson, Khaled A. Nasr and Douglas A. Pepper are the venture members of IMP-9. These individuals share voting and dispositive power over the shares held by IWP-9; however, they disclaim beneficial ownership of the shares held by such entities except to the extent of their pecuniary interests therein. Gilbert H. Kliman, M.D. is a director of the Issuer and, accordingly, files separate Section 16 reports. |
/s/ Katie A. Passalacqua, Attorney-in-Fact for InterWest Management Partners IX, LLC | 06/30/2015 | |
/s/ Katie A. Passalacqua, Attorney-in-Fact for InterWest Partners IX, L.P. | 06/30/2015 | |
/s/ Katie A. Passalacqua, Attorney-in-Fact for Philip T. Gianos | 06/30/2015 | |
/s/ Katie A. Passalacqua, Attorney-in-Fact for W. Stephen Holmes | 06/30/2015 | |
/s/ Katie A. Passalacqua, Attorney-in-Fact for Arnold L. Oronsky | 06/30/2015 | |
/s/ Katie A. Passalacqua, Attorney-in-Fact for Bruce A. Cleveland | 06/30/2015 | |
/s/ Katie A. Passalacqua, Attorney-in-Fact for Nina Kjellson | 06/30/2015 | |
/s/ Katie A. Passalacqua, Attorney-in-Fact for Khaled A. Nasr | 06/30/2015 | |
/s/ Katie A. Passalacqua, Attorney-in-Fact for Douglas A. Pepper | 06/30/2015 | |
** 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 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). | ||
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. |