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) 06/11/2015 | 3. Issuer Name and Ticker or Trading Symbol Invuity, Inc. [ IVTY ] | |||||||||||||
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 D Preferred Stock | (1) | (1) | Common Stock | 31,728 | (1) | D | |
Series D Preferred Stock | (2) | (2) | Common Stock | 286,969 | (2) | I | See footnote(3) |
Series E Preferred Stock | (4) | (4) | Common Stock | 11,584 | (4) | D | |
Series E Preferred Stock | (5) | (5) | Common Stock | 38,065 | (5) | I | See footnote(3) |
Director Stock Option (right to buy) | (6) | 04/16/2025 | Common Stock | 10,810 | 11.1 | D |
Explanation of Responses: |
1. 31,452 outstanding shares of Series D Preferred Stock shall automatically convert into 31,728 shares of Common Stock, on a 1.008821799-for-one basis, immediately prior to the closing of the Issuer's initial public offering of common stock and has no expiration date. |
2. 284,460 outstanding shares of Series D Preferred Stock shall automatically convert into 286,969 shares of Common Stock, on a 1.008821799-for-one basis, immediately prior to the closing of the Issuer's initial public offering of common stock and has no expiration date. |
3. The shares are held by Valence CDK SPV, L.P. ("Valence CDK"). Valence Life Sciences GP II, LLC ("Valence") is the General Partner of Valence CDK. The Reporting Person is a Managing Member of Valence and disclaims beneficial ownership of the shares held by Valence CDK, except to the extent of his pecuniary interest therein. |
4. 11,273 outstanding shares of Series E Preferred Stock shall automatically convert into 11,584 shares of Common Stock, on a 1.027662672-for-one basis, immediately prior to the closing of the Issuer's initial public offering of common stock and has no expiration date. |
5. 38,065 outstanding shares of Series E Preferred Stock shall automatically convert into 39,117 shares of Common Stock, on a 1.027662672-for-one basis, immediately prior to the closing of the Issuer's initial public offering of common stock and has no expiration date. |
6. The option is subject to an early exercise provision and is immediately exercisable. 50% of the shares subject to the option were fully vested as of the grant of such option. One twenty-fourth of the remaining 50% of the shares subject to the option vested on March 13, 2015 and one twenty-fourth of the remaining 50% of the shares subject to the option vest each month thereafter, subject to the Reporting Person continuing as a service provider through each such date. |
Remarks: |
Exhibit 24 - Power of Attorney |
/s/ Nancy Hargreaves, by power of attorney | 06/11/2015 | |
** 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. |