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)
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2. Issuer Name and Ticker or Trading Symbol
Clearside Biomedical, Inc. [ CLSD ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 06/07/2016 | ||||||||||||||||||||||||||
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 | 06/07/2016 | C | 1,598,223(1) | A | (2) | 1,654,248 | I | By Hatteras Venture Partners IV SBIC, LP(3) | ||
Common Stock | 06/07/2016 | X | 21,705 | A | $0.022 | 1,675,953 | I | By Hatteras Venture Partners IV SBIC, LP(3) | ||
Common Stock | 06/07/2016 | S(4) | 69 | D | $7 | 1,675,884 | I | By Hatteras Venture Partners IV SBIC, LP(3) | ||
Common Stock | 06/07/2016 | P | 414,286 | A | $7 | 2,090,170 | I | By Hatteras Venture Partners IV SBIC, LP(3) |
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 A Preferred Stock | (2) | 06/07/2016 | C | 2,035,908 | (2) | (2) | Common Stock | 925,412(2) | $0.00 | 0 | I | By Hatteras Venture Partners IV SBIC, LP(3) | |||
Series A-1 Preferred Stock | (2) | 06/07/2016 | C | 689,388 | (2) | (2) | Common Stock | 313,358(2) | $0.00 | 0 | I | By Hatteras Venture Partners IV SBIC, LP(3) | |||
Series B Preferred Stock | (2) | 06/07/2016 | C | 432,941 | (2) | (2) | Common Stock | 196,791(2) | $0.00 | 0 | I | By Hatteras Venture Partners IV SBIC, LP(3) | |||
Series C Preferred Stock | (2) | 06/07/2016 | C | 337,897 | (2) | (2) | Common Stock | 162,662(2) | $0.00 | 0 | I | By Hatteras Venture Partners IV SBIC, LP(3) | |||
Warrant to Purchase Common Stock (right to buy) | $0.022 | 06/07/2016 | X | 21,705 | 04/28/2014 | (5) | Common Stock | 21,705 | $0.00 | 0 | I | By Hatteras Venture Partners IV SBIC, LP(3) |
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 total represents shares received upon conversion of shares of Series A Preferred Stock, Series A-1 Preferred Stock, Series B Preferred Stock and Series C Preferred Stock. |
2. Effective immediately prior to the closing of the Issuer's initial public offering of its common stock, each share of Series A Preferred Stock, Series A-1 Preferred Stock and Series B Preferred Stock automatically converted into 0.454545 shares of the Issuer's common stock, and each share of Series C Preferred Stock automatically converted into 0.4814 shares of the Issuer's common stock. The Preferred Stock had no expiration date. |
3. The reportable securities are owned directly by Hatteras Venture Partners IV SBIC, LP ("HVP IV"). Hatteras Venture Advisors IV SBIC, LLC is the general partner of HVP IV (the "GP"). The securities directly held by HVP IV are indirectly held by the individual managing members of GP (each, a "GP Managing Member" and collectively, the "GP Managing Members"). The GP Managing Members are John Crumpler, Clay Thorp, Ken Lee, Douglas Reed and Robert Ingram. The GP Managing Members may share voting and dispositive power over the securities directly held by HVP IV. Each GP Managing Member disclaims beneficial ownership of these securities and this report is not an admission that any GP Managing Member is a beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of his pecuniary interest therein. |
4. On June 7, 2016, HVP IV exercised a warrant to purchase 21,705 shares of Issuer's common stock for $0.022 per share. HVP IV paid the exercise price on a cashless basis, resulting in the Issuer's withholding of an aggregate of 69 of the warrant shares to pay the exercise price and issuing to the HVP IV the remaining 21,636 shares. |
5. This warrant would have expired upon the closing of the Issuer's initial public offering. |
Remarks: |
/s/ Brian F. Leaf, Attorney-in-Fact for Hatteras Venture Advisors IV SBIC, LLC | 06/07/2016 | |
/s/ Brian F. Leaf, Attorney-in-Fact for John Crumpler | 06/07/2016 | |
/s/ Brian F. Leaf, Attorney-in-Fact for Douglas Reed | 06/07/2016 | |
/s/ Brian F. Leaf, Attorney-in-Fact for Kenneth Lee | 06/07/2016 | |
/s/ Brian F. Leaf, Attorney-in-Fact for Robert Ingram | 06/07/2016 | |
/s/ Brian F. Leaf, Attorney-in-Fact for Clay Thorp | 06/07/2016 | |
/s/ Brian F. Leaf, Attorney-in-Fact for Hatteras Venture Advisors IV SBIC, LLC, the general partner of Hatteras Venture Partners IV SBIC, LP | 06/07/2016 | |
** 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. |