FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 10/08/2013 |
3. Issuer Name and Ticker or Trading Symbol
LDR HOLDING CORP [ LDRH ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 89,375 | D(1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series A-1 Preferred Stock | (2) | (2) | Common Stock | 329,485 | (2) | D(1) | |
Series A-2 Preferred Stock | (3) | (3) | Common Stock | 40,403 | (3) | D(1) | |
Series B Preferred Stock | (4) | (4) | Common Stock | 296,593 | (4) | D(1) | |
Series C Preferred Stock | (5) | (5) | Common Stock | 317,915 | (5) | D(1) | |
Series C Preferred Stock | (5) | (5) | Common Stock | 606,634 | (5) | D(6) | |
Convertible Notes | (7) | 04/25/2016(7) | Common Stock | 309,537 | (7) | D(6) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. Shares held directly by Pinto Technology Ventures, L.P. ("PTV"). Pinto Technology Ventures GP, L.P. ("PTV GP") is general partner of PTV. Pinto TV GP Company LLC ("TV GP") is the general partner of PTV GP. Matthew Crawford is a manager of TV GP and may be deemed to have beneficial ownership of the shares held by PTV. |
2. The Series A-1 Preferred Stock is convertible into the Issuer's Common Stock on a 6.75 for 1 basis and has no expiration date. |
3. The Series A-2 Preferred Stock is convertible into the Issuer's Common Stock on a 6.75 for 1 basis and has no expiration date. |
4. The Series B Preferred Stock is convertible into the Issuer's Common Stock on a 6.75 for 1 basis and has no expiration date. |
5. The Series C Preferred Stock is convertible into the Issuer's Common Stock on a 6.75 for 1 basis and has no expiration date. |
6. Shares held directly by PTV Sciences II, L.P. ("PTVS II"). Pinto Technology Ventures GP II, L.P. ("PTV GP II") is the general partner of PTVS II. TV GP is the general partner of PTV GP II. Matthew Crawford is a manager of TV GP and may be deemed to have beneficial ownership of the shares held by PTV. |
7. Immediately prior to the closing of the Issuer's initial public offering, the Convertible Notes shall automatically be converted into a number of shares of the Issuer's Common Stock equal to (a) the unpaid principal and accrued but unpaid interest on the Convertible Notes divided by (b) 50% of the price per share of the Issuer's Common Stock sold in the initial public offering. |
Remarks: |
Exhibit 24.1 - Confirming Statement |
/s/ Denise Cruz for PTV Sciences II, L.P. | 10/08/2013 | |
/s/ Denise Cruz for Pinto Technology Ventures GP II, L.P | 10/08/2013 | |
/s/ Denise Cruz for Pinto Technology Ventures, L.P. | 10/08/2013 | |
/s/ Denise Cruz for Pinto Technology Ventures GP, L.P. | 10/08/2013 | |
/s/ Denise Cruz for Pinto TV GP Company LLC | 10/08/2013 | |
/s/ Denise Cruz for Matthew Crawford | 10/08/2013 | |
** 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 5 (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. |