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 of Derivative Security: 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 B Preferred Stock
(1)
|
10/10/2007(2)
|
10/10/2007(3)
|
Common Stock
|
1,091,815
(4)
|
$
0
(5)
|
I
|
See footnote
(6)
|
Series C Preferred Stock
(1)
|
10/10/2007(2)
|
10/10/2007(3)
|
Common Stock
|
448,963
(4)
|
$
0
(5)
|
I
|
See footnote
(7)
|
Series D Preferred Stock
(1)
|
10/10/2007(2)
|
10/10/2007(3)
|
Common Stock
|
629,829
(4)
|
$
0
(5)
|
I
|
See footnote
(8)
|
* |
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). |
(1) |
Automatically Convertible into shares of Common Stock upon the closing of the MAP Pharmaceuticals, Inc. Initial Public Offering. |
(2) |
Immediately Convertible. |
(3) |
Not Applicable. |
(4) |
Reflects 1-for-1 conversion into shares of Common Stock. |
(5) |
1-for-1 |
(6) |
Represents 1,068,779 shares held by Bay City Capital Fund IV, L.P. and 23,036 shares held by Bay City Capital Fund IV Co-Investment Fund, L.P. Dr. Goldfischer is a Managing Director of Bay City Capital, an affiliate of Bay City Capital Fund IV, L.P. and Bay City Capital Fund IV Co-Investment Fund, L.P. and disclaims beneficial ownership of the shares except to the extent of his pecuniary interest therein. |
(7) |
Represents 439,490 shares held by Bay City Capital Fund IV, L.P. and 9,473 shares held by Bay City Capital Fund IV Co-Investment Fund, L.P. Dr. Goldfischer is a Managing Director of Bay City Capital, an affiliate of Bay City Capital Fund IV, L.P. and Bay City Capital Fund IV Co-Investment Fund, L.P. and disclaims beneficial ownership of the shares except to the extent of his pecuniary interest therein. |
(8) |
Represents 616,540 shares held by Bay City Capital Fund IV, L.P. and 13,289 shares held by Bay City Capital Fund IV Co-Investment Fund, L.P. Dr. Goldfischer is a Managing Director of Bay City Capital, an affiliate of Bay City Capital Fund IV, L.P. and Bay City Capital Fund IV Co-Investment Fund, L.P. and disclaims beneficial ownership of the shares except to the extent of his pecuniary interest therein. |