0001209191-15-033293.txt : 20150408 0001209191-15-033293.hdr.sgml : 20150408 20150408212624 ACCESSION NUMBER: 0001209191-15-033293 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150408 FILED AS OF DATE: 20150408 DATE AS OF CHANGE: 20150408 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Carbylan Therapeutics, Inc. CENTRAL INDEX KEY: 0001348911 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3181 PORTER DRIVE CITY: PALO ALTO STATE: CA ZIP: 94304 BUSINESS PHONE: 650-855-6777 MAIL ADDRESS: STREET 1: 3181 PORTER DRIVE CITY: PALO ALTO STATE: CA ZIP: 94304 FORMER COMPANY: FORMER CONFORMED NAME: Carbylan Biosurgery, Inc DATE OF NAME CHANGE: 20130102 FORMER COMPANY: FORMER CONFORMED NAME: Carbylan Biosurgery Inc DATE OF NAME CHANGE: 20060105 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: VIVO VENTURES VI AFFIILATES FUND, L.P. CENTRAL INDEX KEY: 0001400245 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36830 FILM NUMBER: 15760235 BUSINESS ADDRESS: STREET 1: 575 HIGH STREET, SUITE 201 CITY: PALP ALTO CALIFORNIA STATE: CA ZIP: 94301 MAIL ADDRESS: STREET 1: 575 HIGH STREET, SUITE 201 CITY: PALP ALTO CALIFORNIA STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Vivo Ventures Fund VI, L.P. CENTRAL INDEX KEY: 0001469473 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36830 FILM NUMBER: 15760236 BUSINESS ADDRESS: STREET 1: 575 HIGH STREET, SUITE 201 CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: (650) 688-0818 MAIL ADDRESS: STREET 1: 575 HIGH STREET, SUITE 201 CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Vivo Ventures VI, LLC CENTRAL INDEX KEY: 0001469547 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36830 FILM NUMBER: 15760237 BUSINESS ADDRESS: STREET 1: 575 HIGH STREET, SUITE 201 CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: (650) 688-0818 MAIL ADDRESS: STREET 1: 575 HIGH STREET, SUITE 201 CITY: PALO ALTO STATE: CA ZIP: 94301 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2015-04-08 0 0001348911 Carbylan Therapeutics, Inc. CBYL 0001469547 Vivo Ventures VI, LLC C/O VIVO CAPITAL LLC 575 HIGH STREET, SUITE 201 PALO ALTO CA 94301 0 0 1 0 0001469473 Vivo Ventures Fund VI, L.P. 575 HIGH STREET, SUITE 201 PALO ALTO CA 94301 0 0 1 0 0001400245 VIVO VENTURES VI AFFIILATES FUND, L.P. 575 HIGH STREET, SUITE 201 PALO ALTO CA 94301 0 0 1 0 Series B Convertible Preferred Stock Common Stock 2476452 I See Footnote Series B Convertible Preferred Stock Common Stock 18142 I See Footnote Convertible Promissory Note Common Stock 387960 I See Footnote Convertible Promissory Note Common Stock 2842 I See Footnote Convertible Promissory Note Common Stock 304438 I See Footnote Convertible Promissory Note Common Stock 2230 I See Footnote The Series B Convertible Preferred Stock is convertible into Common Stock on a one for one basis, at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. The reported shares are held directly by Vivo Ventures Fund VI, LP. ("VIF"). Vivo Ventures VI, LLC ("Vivo LLC") is the general partner of VIF. As such, Vivo LLC may be deemed to be the beneficial owner of the shares held directly by VIF. The managers of Vivo LLC include Frank Kung, Edgar Engleman, and Albert Cha. Accordingly, each Frank Kung, Edgar Engleman and Albert Cha may be deemed to be the beneficial owner of the shares held directly by VIF. Each of Vivo LLC, Frank Kung, Edgar Engleman and Albert Cha disclaims beneficial ownership of the securities held by VIF, except to the extent of such individual's or entity's pecuniary interests in the securities. The reported shares are held directly by Vivo Ventures VI Affiliates Fund, LP. ("VIAF"). Vivo Ventures VI, LLC ("Vivo LLC") is the general partner of VIAF. As such, Vivo LLC may be deemed to be the beneficial owner of the shares held directly by VIAF. The managers of Vivo LLC include Frank Kung, Edgar Engleman, and Albert Cha. Accordingly, each Frank Kung, Edgar Engleman and Albert Cha may be deemed to be the beneficial owner of the shares held directly by VIAF. Each of Vivo LLC, Frank Kung, Edgar Engleman and Albert Cha disclaims beneficial ownership of the securities held by VIAF, except to the extent of such individual's or entity's pecuniary interests in the securities. The Convertible Promissory Note is convertible into the number of shares of the Issuer's Common Stock equal to the quotient obtained by dividing the entire principal amount and 184 days of accrued interest on the Convertible Promissory Note by 80% of the initial public offering price of $5.00 per share of the Issuer's Common Stock, automatically upon the closing of the Issuer's initial public offering, and has no expiration date. The Convertible Promissory Note is convertible into the number of shares of the Issuer's Common Stock equal to the quotient obtained by dividing the entire principal amount and 41 days of accrued interest on the Convertible Promissory Note by 80% of the initial public offering price of $5.00 per share of the Issuer's Common Stock, automatically upon the closing of the Issuer's initial public offering, and has no expiration date. By: /s/ Albert Cha, M.D., Ph.D. Managing Member of Vivo Ventures VI, LLC, the General Partner of Vivo Ventures VI Fund L.P. and Vivo Ventures VI Affiliates Fund, L.P. 2015-04-08