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Orrick's Emerging Companies Group

Start-Up Forms Library


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[COMPANY NAME]
Capitalization Table
as of 08/30/2009
Original Antidilution Fully
Issuance Adjustments Diluted
I. Common Stock (__________ shares authorized)
A. Issued and Outstanding 0 0

II. Preferred Stock (__________ shares authorized)


A. Series A Issued and Outstanding (________ shares designated) 0 0 0
B. Series B Issued and Outstanding (________ shares designated) 0 0 0
C. Series B Warrants (as converted) 0 0
D. Series C Issued and Outstanding (_________ shares designated) 0 0 0

III. [_____ Stock Plan]


A. Maximum number of shares authorized under Plan 0
B. Options
B1. Total Option Grants 0
B2. Less: Cancelled and Expired Option Grants - Put Back in Plan 0
B3. Less: Total Option Exercises (1) 0
B4. Equals: Total Options Outstanding (B1-B2-B3) 0
C. Restricted Stock (RSP) Issuances
C1. Total RSP Grants 0
C2. Less: Repurchased RSP Issuances - Not Back in Plan 0
C3. Equals: Net RSP Issuances - Outstanding (1) 0
D. Shares Available for Future Option/RSP Grants
D1. (A-B3-B4-C1) 0
E. Shares Remaining Under Plan
(shares available for stock or option grants as well as outstanding options)

E1. (B4+D1) 0 0

IV. Total Shares Issued and Outstanding, Including Shares Committed for 0 0
Issuance and Employee Reserves, Assuming Conversion of All
Convertible Securities and Exercise of All Outstanding Options

(1) Included under "Common Stock - Issued and Outstanding".

FULLY DILUTED

Breakdown of Ownership
Overall Shares %
I. Common Stock 0 #DIV/0!
II. Series A Preferred Stock 0 #DIV/0!
III. Series B Preferred Stock 0 #DIV/0!
IV. Series B Warrants 0 #DIV/0!
V. Series C Preferred Stock 0 #DIV/0!
VI. 2002 Stock Plan (options issued and available for issue) 0 #DIV/0!
TOTAL: 0 #DIV/0!

US_WEST:22923984.1 rev. 08/30/2009


Antidilution Calculations

Antidilution Calculations:

Shares Current New New Add'l C.S. Aggregate Add'l C.S. Total Preferred (as-converted)
Currently Conversion Conversion Conversion (issuable upon conversion of (issuable upon conversion of Outstanding
Outstanding Price Price Ratio each share of Preferred) all Preferred) After Adjustment

Series A - $1.0000 $1.0000 1.0000 0.0000 - -


Series B - $1.0000 $1.0000 1.0000 0.0000 - -
Series C - $1.0000 $1.0000 1.0000 0.0000 - -

Common Stock - Total New Shares -


Series B Warrants -
Options -

Assumptions:
Price Per Share $1.00
Amount Raised $0.00
Outstanding Common -

Formulas:
New Conversion Price = Current Conversion Price x (Outstanding Common + (Amount Raised / Current Conversion Price))
(Outstanding Common + (Amount Raised / Price Per Share))

Outstanding Common = Shares of Common Stock outstanding + Shares of Common Stock issuable upon conversion or exercise of outstanding Preferred Stock, options and warrants
Common Stock

Cert. Grant Termin. Shares Xfer to Cert. Xfer from


No. Name Shares % of CS Price BOD Date Date Cert. Date Date Transferred No. Cert. No. Consideration Acquired Pursuant to
CS-1 [Last] [First] - #DIV/0! $- [cash] [Common Stock Purchase]

Total Shares 0 #DIV/0! 0

DOCSSV1:292874.1 rev. 08/30/2009


Series A Preferred Stock

Cert. Shares Xfer to Xfer from


No. Name Shares % of PSA Price BOD Date Cert. Date Transferred Cert. No. Cert. No. Consideration
PA-1 [Last] [First] - #DIV/0! $- 1/26/05 1/26/05 [cash]

Total Shares 0 #DIV/0! -

DOCSSV1:292874.1 rev. 08/30/2009


Series B Preferred Stock

Cert. Shares Xfer to Cert. Xfer from


No. Name Shares % of PSA Price BOD Date Cert. Date Transferred No. Cert. No. Consideration
PB-1 [Last] [First] - #DIV/0! $- 1/26/05 1/26/05 [cash]

Total Shares 0 #DIV/0! -

DOCSSV1:292874.1 rev. 08/30/2009


Series B Warrants

Wrt % of BOD Date of Amount Expiration


No. Name Shares WB Date Issuance Cancelled Date Status
WB-1 [Name] - #DIV/0! 1/26/05 1/26/05 1/26/15 [Outstanding]

Total Shares - #DIV/0! -

DOCSSV1:292874.1 rev. 08/30/2009


Series C Preferred Stock

Cert. Shares Xfer to Cert. Xfer from


No. Name Shares % of PSA Price BOD Date Cert. Date Transferred No. Cert. No. Consideration
PC-1 [Last] [First] - #DIV/0! $- 1/26/05 1/26/05 [cash]

Total Shares 0 #DIV/0! -

DOCSSV1:292874.1 rev. 08/30/2009


Stock Plan

ISO, Vesting ISO or NSO ISO or NSO ISO or NSO Optionee


Number of NSO or Comm. Termin. Shares RSP Shares Exercise Vested Shares Options Purchased RSP ISO or NSO
Name Shares RSP Price BOD Date Grant Date Date Date Returned Repurchased Date Shares Exercised Outstanding Shares Grants RSP Grants Rule 701
[Name] - [ISO] $- 1/26/05 1/26/05 1/26/05 #NAME? - $-
[Name] - [RSP] $- 1/26/05 1/26/05 1/26/05 #NAME? - $-

Total - - - #NAME? - - - - - $-

Total Authorized Pool -


Total Options/Shares Granted -
Available Under Plan -

Options granted in a 12-month period for 1.26.05


BofD--complies with Rule 701 $-
-LESS THAN 1MM-

DOCSSV1:292874.1 rev. 08/30/2009


Vesting Calculations

Vested Options and Restricted Stock Date: 8/30/09


8/30/09 11:31 1 # of
Pre-split Post-split Vesting Vesting Periods Vested
Full Outstanding Outstanding Start Narrative As Of As Of
Name ISO/NSO/RSP Options Options Date Formula 8/30/09 8/30/09

[Name] [ISO] - - 0 1/26/05 1/4 at 1 yr., 1/48 per month thereafter #NAME? #NAME?
[Name] [RSP] - - 0 1/26/05 1/4 at 1 yr., 1/48 per month thereafter #NAME? #NAME?

- 0 0 #NAME?

Sample Formulas 1/36 per month #NAME? #NAME?


1/48 per month #NAME? #NAME?

DOCSSV1:292874.1 rev. 08/30/2009


Notes

I4: $100K ISO Limit is not reflected where applicable.

DOCSSV1:292874.1 rev. 08/30/2009


Change of Control

Acceleration of Vesting upon


Name Change of Control BofD Approval
[Name] [Yes; RSPA] 1/26/05
[Name] [Yes; RSPA] 1/26/05

DOCSSV1:292874.1 rev. 08/30/2009

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