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) 05/12/2004 |
3. Issuer Name and Ticker or Trading Symbol
NUVASIVE INC [ NUVA ] |
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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) |
Series A Preferred Stock(1) | 2,137,500 | I | See footnotes(2)(7) |
Series B Preferred Stock(1) | 1,090,909 | I | See footnotes(3)(7) |
Series C Preferred Stock(1) | 376,923 | I | See footnotes(4)(7) |
Series D Preferred Stock(1) | 988,143 | I | See footnotes(5)(7) |
Series D-1 Preferred Stock(1) | 664,177 | I | See footnotes(6)(7) |
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 | ||||
Warrant (Right to Purchase Common Stock)(10) | 07/11/2002 | 07/11/2009 | Common Stock | 47,820 | $0.63 | I | See footnotes(7)(8) |
Warrant (Right to Purchase Common Stock)(10) | 07/29/2002 | 07/11/2009 | Common Stock | 3,944 | $0.63 | I | See footnotes(7)(8) |
Warrant (Right to Purchase Common Stock)(10) | 07/19/2003 | 06/19/2010 | Common Stock | 52,624 | $0.63 | I | See footnotes(7)(8) |
Warrant (Right to Purchase Series B Preferred Stock)(10) | 10/13/1999 | 10/13/2004 | Series B Preferred Stock | 41,467 | $2.75 | I | See footnotes(7)(8) |
Warrant (Right to Purchase Series D Preferred Stock)(10) | 02/14/2001 | 02/14/2006 | Series D Preferred Stock | 62,006 | $2.35 | I | See footnotes(7)(8) |
Warrant (Right to Purchase Series D Preferred Stock)(10) | 04/12/2001 | 04/12/2006 | Series D Preferred Stock | 11,584 | $2.35 | I | See footnotes(7)(8) |
Warrant (Right to Purchase Common Stock)(10) | 07/11/2002 | 07/11/2009 | Common Stock | 2,772 | $0.63 | I | See footnotes(7)(9) |
Warrant (Right to Purchase Common Stock)(10) | 07/29/2002 | 07/11/2009 | Common Stock | 229 | $0.63 | I | See footnotes(7)(9) |
Warrant (Right to Purchase Common Stock)(10) | 06/19/2003 | 06/19/2010 | Common Stock | 3,050 | $0.63 | I | See footnotes(7)(9) |
Warrant (Right to Purchase Series B Preferred Stock)(10) | 10/13/1999 | 10/13/2004 | Series B Preferred Stock | 2,405 | $2.75 | I | See footnotes(7)(9) |
Warant (Right to Purchase Series D Preferred Stock)(10) | 02/14/2001 | 02/14/2006 | Series D Preferred Stock | 3,595 | $2.53 | I | See footnotes(7)(9) |
Warrant (Right to Purchase Series D Preferred Stock)(10) | 04/12/2001 | 04/12/2006 | Series D Preferred Stock | 672 | $2.53 | I | See footnotes(7)(9) |
Explanation of Responses: |
1. Immediately following the closing of the initial public offering of the Issuer's Common Stock, all outstanding shares of Preferred Stock will be automatically converted into shares of the Issuer's Common Stock. |
2. Represents 2,020,361 shares beneficially owned by Kleiner Perkins Caufield & Byers VIII, L.P., and 117,139 shares beneficially owned by KPCB VIII Founders Fund, L.P. |
3. Represents 1,031,127 shares beneficially owned by Kleiner Perkins Caufield & Byers VIII, L.P., and 59,782 shares beneficially owned by KPCB VIII Founders Fund, L.P. |
4. Represents 356,268 shares beneficially owned by Kleiner Perkins Caufield & Byers VIII, L.P., and 20,655 shares beneficially owned by KPCB VIII Founders Fund, L.P. |
5. Represents 933,993 shares beneficially owned by Kleiner Perkins Caufield & Byers VIII, L.P. and 54,150 shares beneficially owned by KPCB VIII Founders Fund, L.P. |
6. Represents 627,780 shares beneficially owned by Kleiner Perkins Caufield & Byers VIII, L.P. and 36,397 shares beneficially owned by KPCB VIII Founders Fund, L.P. |
7. KPCB VIII Associates, L.P., a California limited partnership ("KPCB VIII Associates") is the general partner of Kleiner Perkins Caufield & Byers VIII, L.P., a California limited partnership ("KPCB VIII") and KPCB VIII Founders Fund, L.P., a California limited partnership ("KPCB VIII FF"). KPCB VIII Associates disclaims beneficial ownership of these shares and warrants held directly by KPCB VIII and KPCB VIII FF, except to the extent of any indirect pecuniary interest in their distributive share therein. |
8. Represents warrants beneficially owned by Kleiner Perkins Caufield & Byers VIII, L.P. |
9. Represents warrants beneficially owned by KPBC VIII Founders Fund, L.P. |
10. This warrant will be automatically exercised for shares of common stock upon the closing of the initial public offering of the Issuer's Common Stock pursuant to the cashless exercise provisions contained therein, based on the price to the public in such offering. |
/s/ Jacob S. Lacob, general partner | 05/12/2004 | |
** 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. |