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