0001209191-15-034049.txt : 20150414
0001209191-15-034049.hdr.sgml : 20150414
20150414171938
ACCESSION NUMBER: 0001209191-15-034049
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150414
FILED AS OF DATE: 20150414
DATE AS OF CHANGE: 20150414
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36830
FILM NUMBER: 15769948
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36830
FILM NUMBER: 15769949
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36830
FILM NUMBER: 15769950
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
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2015-04-14
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
Common Stock
2015-04-14
4
C
0
2476452
A
2476452
I
See Footnote
Common Stock
2015-04-14
4
C
0
18142
A
2494594
I
See Footnote
Common Stock
2015-04-14
4
C
0
387960
A
2882554
I
See Footnote
Common Stock
2015-04-14
4
C
0
2842
A
2885396
I
See Footnote
Common Stock
2015-04-14
4
C
0
304438
A
3189834
I
See Footnote
Common Stock
2015-04-14
4
C
0
2230
A
3192064
I
See Footnote
Common Stock
2015-04-14
4
P
0
1005136
5.00
A
4197200
I
See Footnote
Common Stock
2015-04-14
4
P
0
7364
5.00
A
4204564
I
See Footnote
Series B Convertible Preferred Stock
2015-04-14
4
C
0
2476452
D
Common Stock
2476452
0
I
See Footnote
Series B Convertible Preferred Stock
2015-04-14
4
C
0
18142
D
Common Stock
18142
0
I
See Footnote
Convertible Promissory Note
2015-04-14
4
C
0
387960
D
Common Stock
387960
0
I
See Footnote
Convertible Promissory Note
2015-04-14
4
C
0
2842
D
Common Stock
2842
0
I
See Footnote
Convertible Promissory Note
2015-04-14
4
C
0
304438
D
Common Stock
304438
0
I
See Footnote
Convertible Promissory Note
2015-04-14
4
C
0
2230
D
Common Stock
2230
0
I
See Footnote
Upon the closing of the Issuer's initial public offering, each share of Series B Convertible Preferred Stock automatically converted into Common Stock on a one for one basis without payment or further consideration, and has no expiration date.
The reported shares are held directly by Vivo Ventures Fund VI, L.P. ("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, L.P. ("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.
2015-04-14