UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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 control number. |
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) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
BALLAND THOMAS C/O EYEGATE PHARMACEUTICALS, INC. 271 WAVERLEY OAKS ROAD, SUITE 108 WALTHAM, MA 02452 |
X |
/s/ Authorized Signatory* | 02/12/2015 | |
**Signature of Reporting Person | Date |
* | 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) | Mr. Balland does not own shares in his individual capacity. He is the managing director of Innoven Partenaires S.A. ("IPSA"), a Reporting Person and manager of Innoven 2003 FCPI No7, Innoven 2002 FCPI No6, FCPI Innoven Europe, FCPI Innoven Europe 2, FCPI Innoven Europe 3, FCPI Innoven Capital, FCPI Innoven Capital 2, FCPI Poste Innovation, FCPI Poste Innovation 2, FCPI Poste Innovation 3, FCPI Poste Innovation 5, FCPI Poste Innovation 6, FCPI Poste Innovation 9 and FCPI La Banque Postale Innovation 1 (collectively, the "Funds"). (continue with footnote 2) |
(2) | Voting and investment power over the Issuer's derivative and non-derivative securities held by the Funds (collectively, the "Fund Shares") may be deemed to be shared with IPSA due to the affiliate relationship. As managing director of IPSA, Mr. Balland may be deemed to share voting and investment power with respect to the Fund Shares. Mr. Balland disclaims beneficial ownership of the Fund Shares, except to the extent of his pecuniary interest therein. |
Remarks: *Signed under power of attorney on behalf of Reporting Person |