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