SEC Form 4
| FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol DoorDash, Inc. [ DASH ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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| 3. Date of Earliest Transaction (Month/Day/Year) 05/18/2021 | ||||||||||||||||||||||||||
| 4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Code | V | Amount | (A) or (D) | Price | ||||||
| Class A Common Stock | 05/18/2021 | J(1) | 3,469,320 | D | $0.00 | 164,595 | I | See footnote(2) | ||
| Class A Common Stock | 05/18/2021 | J(3) | 845,821 | A | $0.00 | 928,629 | I | See footnote(4) | ||
| Class A Common Stock | 05/18/2021 | J(5) | 727,236 | D | $0.00 | 201,393 | I | See footnote(4) | ||
| Class A Common Stock | 05/18/2021 | J(6) | 117,542 | A | $0.00 | 199,631 | I | See footnote(7) | ||
| Class A Common Stock | 05/18/2021 | J(8) | 264,831 | A | $0.00 | 449,740 | I | See footnote(9) | ||
| Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Explanation of Responses: |
| 1. Represents a pro-rata in-kind distribution of Class A Common Stock of the Issuer by KPCB Digital Growth Fund II, LLC ("KPCB Growth") and KPCB DGF Founders Fund II, LLC ("KPCB FF") without consideration to their members (the "Fund Distribution"). |
| 2. The shares are held for convenience in the name of KPCB Holdings, Inc., as nominee for the accounts of KPCB Digital Growth Fund II, LLC and KPCB Digital Growth Founders Fund II, LLC, (collectively, the "KPCB Entities"). As a managing member of KPCB DGF II Associates, LLC ("DGF II Associates"), the managing member of the KPCB Entities, the Reporting Person shares voting and dispositive control with respect to the shares held by KPCB Holdings, Inc., as nominee. The Reporting Person disclaims beneficial ownership of these shares except to the extent of any pecuniary interest therein. |
| 3. Represents a change in the form of ownership from indirect to direct by virtue of the receipt of shares in the Fund Distribution. |
| 4. The shares are held directly by DGF II Associates. The Reporting Person is a managing member of DGF II Associates and may be deemed to share voting and investment power over the securities held by DGF II Associates. The Reporting Person disclaims beneficial ownership over such securities except to the extent of his pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes. |
| 5. Represents a pro-rata in-kind distribution of Class A Common Stock of the Issuer by DGF II Associates without consideration to its members (the "DGF II Associates Distribution"). |
| 6. Represents the receipt of shares of Class A Common Stock of the Issuer by virtue of the receipt of shares in the DGF II Associates distribution. |
| 7. Shares are held by the Vallejo Ventures Trust for which the Reporting Person and his spouse serve as trustees. |
| 8. Represents the receipt of shares of Class A Common Stock of the Issuer by virtue of the Fund Distribution and the DGF II Associates Distribution. |
| 9. Shares are held by investment entities controlled by the Reporting Person. |
| Remarks: |
| /s/ Rob Moreno, Attorney-in-fact | 05/20/2021 | |
| ** Signature of Reporting Person | Date | |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
| * If the form is filed by more than one reporting person, see Instruction 4 (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). | ||
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
| 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 Number. | ||