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, Section 17(a) of the Public Utility Holding Company Act of 1935 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 | ||||
Series A Preferred Stock | Â (4) | Â (5) | Common Stock | 162,954 (6) | $ 0 | D (1) | Â |
Series A Preferred Stock | Â (4) | Â (5) | Common Stock | 2,202,140 (6) | $ 0 | D (2) | Â |
Series A Preferred Stock | Â (4) | Â (5) | Common Stock | 2,365,094 (6) | $ 0 | I | See footnote (3) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Impact Venture Advisors, LLC 2705 WESTLAKE DRIVE AUSTIN, TX 78746 |
 |  X |  |  |
IMPACT VENTURE PARTNERS LP 2705 WESTLAKE DRIVE AUSTIN, TX 78746 |
 |  X |  |  |
IMPACT ENTREPRENEURS FUND LP 2705 WESTLAKE DRIVE AUSTIN, TX 78746 |
 |  X |  |  |
/s/ Adam R. Dell | 05/20/2009 | |
**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) | The shares are held directly by Impact Entrepreneurs Fund, L.P. ("IEF"). |
(2) | The shares are held directly by Impact Venture Partners, L.P. ("IVP"). |
(3) | Impact Venture Advisors, LLC ("IVA"), the Designated Filer, is the sole general partner of each of IEF and IVP and may be deemed to have sole voting and dispositive power over the common stock reported in column 2 of Table I and the underlying shares of common stock reported in column 3 of Table II held directly by IEF and IVP. Adam R. Dell, the manager of IVA may also be deemed to have sole voting and dispositive power over the common stock reported in column 2 of Table I and the underlying shares of common stock reported in column 3 of Table II held directly by IEF and IVP. IVA and Mr. Dell disclaim beneficial ownership of such shares except to the extent of any pecuniary interest therein. |
(4) | The securities are immediately convertible. |
(5) | The expiration date is not relevant to the conversion of these securities. |
(6) | Each share of preferred stock will automatically convert on a 1-for-1 basis into common stock upon the closing of the Issuer's initial public offering. |