0001209191-15-034051.txt : 20150414 0001209191-15-034051.hdr.sgml : 20150414 20150414172250 ACCESSION NUMBER: 0001209191-15-034051 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: NOHRA GUY P CENTRAL INDEX KEY: 0001198330 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36830 FILM NUMBER: 15769979 MAIL ADDRESS: STREET 1: ONE EMBARCADERO CENTER SUITE 3700 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2015-04-14 0 0001348911 Carbylan Therapeutics, Inc. CBYL 0001198330 NOHRA GUY P C/O ACP IV, L.P. ONE EMBARCADERO CENTER, SUITE 3700 SAN FRANCISCO CA 94111 1 0 0 0 Common Stock 2015-04-14 4 C 0 727590 A 727590 I See Footnote Common Stock 2015-04-14 4 C 0 1981124 A 2708714 I See Footnote Common Stock 2015-04-14 4 C 0 424346 A 3133060 I See Footnote Common Stock 2015-04-14 4 C 0 332990 A 3466050 I See Footnote Common Stock 2015-04-14 4 P 0 877500 5.00 A 4343550 I See Footnote Series A Convertible Preferred Stock 2015-04-14 4 C 0 727590 D Common Stock 727590 0 I See Footnote Series B Convertible Preferred Stock 2015-04-14 4 C 0 1981124 D Common Stock 1981124 0 I See Footnote Convertible Promissory Note 2015-04-14 4 C 0 424346 D Common Stock 424346 0 I See Footnote Convertible Promissory Note 2015-04-14 4 C 0 332990 D Common Stock 332990 0 I See Footnote Upon the closing of the Issuer's initial public offering, each share of Series A Convertible Preferred Stock and 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. These securities are held by ACP IV, L.P ("ACP IV"). Daniel S. Janney and Guy P. Nohra are directors of ACMP IV, LLC, the general partner of ACP IV and disclaim beneficial ownership of these securities except to the extent of any pecuniary interest therein. 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/ David J. Saul, Attorney-in-Fact 2015-04-14