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 AVEDRO INC [ AVDR ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 02/19/2019 | ||||||||||||||||||||||||||
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 | 02/19/2019 | C | 2,247,190 | A | (1) | 2,348,802 | I | See Footnote(2) | ||
Common Stock | 02/19/2019 | C | 222,119 | A | (1) | 2,570,921 | I | See Footnote(2) | ||
Common Stock | 02/19/2019 | C | 171,318 | A | (1) | 2,742,239 | I | See Footnote(2) | ||
Common Stock | 02/19/2019 | P | 25,000 | A | $14 | 25,000 | D |
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 AA Convertible Preferred Stock | (1) | 02/19/2019 | C | 2,247,190 | (1) | (1) | Common Stock | 2,247,190 | $0.00 | 0 | I | See Footnote(2) | |||
Series BB Convertible Preferred Stock | (1) | 02/19/2019 | C | 222,119 | (1) | (1) | Common Stock | 222,119 | $0.00 | 0 | I | See Footnote(2) | |||
Series CC Convertible Preferred Stock | (1) | 02/19/2019 | C | 171,318 | (1) | (1) | Common Stock | 171,318 | $0.00 | 0 | I | See Footnote(2) | |||
Stock Option (right to buy) | $12.73 | 02/19/2019 | A | 8,314 | (3) | 01/08/2029 | Common Stock | 8,314 | $0.00 | 8,314 | D |
Explanation of Responses: |
1. Each share of Series AA Convertible Preferred Stock, Series BB Convertible Preferred Stock and Series CC Convertible Preferred Stock was convertible at any time, at the option of the holder, into Common Stock, on a one-for-one basis, had no expiration date and converted into shares of Common Stock upon the closing of the Issuer's initial public offering. |
2. The shares are directly held by InterWest Partners X, LP ("InterWest X"). InterWest Management Partners X, LLC ("IMP X"), as the general partner of InterWest X, may be deemed to beneficially own the shares held by InterWest X. The Reporting Person is a managing director of IMP X, and as such may be deemed to beneficially own the shares held by InterWest X. The Reporting Person disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein. |
3. One hundred percent (100%) of the shares subject to the option shall vest on the earlier of (x) June 1, 2020 and (y) the first anniversary of the first annual meeting of the Issuer's stockholders following the Issuer's initial public offering, subject to the Reporting Person continuing to provide service through such date. |
Remarks: |
/s/ Paul S. Bavier, Attorney-in-Fact | 02/19/2019 | |
** 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. |