0001209191-16-126265.txt : 20160607
0001209191-16-126265.hdr.sgml : 20160607
20160607164107
ACCESSION NUMBER: 0001209191-16-126265
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160607
FILED AS OF DATE: 20160607
DATE AS OF CHANGE: 20160607
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Clearside Biomedical, Inc.
CENTRAL INDEX KEY: 0001539029
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 452437375
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1220 OLD ALPHARETTA RD
STREET 2: SUITE 300
CITY: ALPHARETTA
STATE: GA
ZIP: 30005
BUSINESS PHONE: 678-270-4005
MAIL ADDRESS:
STREET 1: 1220 OLD ALPHARETTA RD
STREET 2: SUITE 300
CITY: ALPHARETTA
STATE: GA
ZIP: 30005
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: White Daniel H.
CENTRAL INDEX KEY: 0001664697
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37783
FILM NUMBER: 161701723
MAIL ADDRESS:
STREET 1: C/O CLEARSIDE BIOMEDICAL, INC.
STREET 2: 1220 OLD ALPHARETTA ROAD, SUITE 300
CITY: ALPHARETTA
STATE: GA
ZIP: 30005
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2016-06-07
0
0001539029
Clearside Biomedical, Inc.
CLSD
0001664697
White Daniel H.
C/O CLEARSIDE BIOMEDICAL, INC.
1220 OLD ALPHARETTA ROAD, SUITE 300
ALPHARETTA
GA
30005
1
1
0
0
President and CEO
Common Stock
2016-06-07
4
C
0
66518
A
530163
D
Common Stock
2016-06-07
4
X
0
657
0.022
A
530820
D
Common Stock
2016-06-07
4
S
0
3
7.00
D
530817
D
Common Stock
40909
I
By White Family Trust
Common Stock
301
I
As UTMA custodian for son
Common Stock
844
I
As UTMA custodian for son
Common Stock
1188
I
As UTMA custodian for son
Series A Preferred Stock
2016-06-07
4
C
0
133234
0.00
D
Common Stock
60560
0
D
Series B Preferred Stock
2016-06-07
4
C
0
13110
0.00
D
Common Stock
5958
0
D
Warrant to Purchase Common Stock (right to buy)
0.022
2016-06-07
4
X
0
657
0.00
D
2014-04-28
Common Stock
657
0
D
Represents shares received upon conversion of shares of Series A Preferred Stock and Series B Preferred Stock.
Effective immediately prior to the closing of the Issuer's initial public offering of its common stock, each share of Series A Preferred Stock and Series B Preferred Stock automatically converted into 0.454545 shares of the Issuer's common stock. The Preferred Stock had no expiration date.
On June 7, 2016, the reporting person exercised a warrant to purchase 657 shares of Issuer's common stock for $0.022 per share. The reporting person paid the exercise price on a cashless basis, resulting in the issuer's withholding of 3 of the warrant shares to pay the exercise price and issuing to the reporting person the remaining 654 shares.
These securities are held in trust for the benefit of the reporting person's children. The reporting person's wife serves as trustee of the trust. The reporting person disclaims beneficial ownership of these securities, and the filing of this report is not an admission that the reporting person is the beneficial owner of these securities for purposes of Section 16 or for any other purpose.
These securities are held for the benefit of the reporting person's son under the Georgia Uniform Transfers to Minors Act, for which the reporting person serves as custodian. The reporting person disclaims beneficial ownership of these shares, and this report shall not be deemed an admission that the reporting person is the beneficial owner of these shares for purposes of Section 16 or for any other purpose.
This warrant would have expired upon the closing of the Issuer's initial public offering.
/s/ Brian F. Leaf, Attorney-in-Fact
2016-06-07