SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL 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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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 11/19/2018 | 3. Issuer Name and Ticker or Trading Symbol Quotient Technology Inc. [ QUOT ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. 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 Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 1,238 | D | |
Common Stock | 3,000(1) | D | |
Common Stock | 8,000(2) | D | |
Common Stock | 10,000(3) | D | |
Common Stock | 18,750(4) | D | |
Common Stock | 12,500(4) | D | |
Common Stock | 74,375(5) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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: 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 | ||||
Employee Stock Option (right to buy) | (6) | 05/05/2027 | Common Stock | 50,000 | 11.4 | D |
Explanation of Responses: |
1. Represents shares underlying outstanding restricted stock units payable solely in common stock of the Issuer that vest in four equal annual installments. The restricted stock units were originally granted on February 5, 2015 for 12,000 shares. |
2. Represents shares underlying outstanding restricted stock units payable solely in common stock of the Issuer that vest in four equal annual installments. The restricted stock units were originally granted on July 31, 2015 for 32,000 shares. |
3. Represents shares underlying outstanding restricted stock units payable solely in common stock of the Issuer that vest in four equal annual installments. The restricted stock units were originally granted on April 26, 2016 for 20,000 shares. |
4. Represents shares underlying outstanding restricted stock units payable solely in common stock of the Issuer that vest in four equal annual installments. The restricted stock units were originally granted on May 5, 2017 for 25,000 shares. |
5. Represents shares underlying outstanding restricted stock units payable solely in common stock of the Issuer that vest in 6.25% quarterly installments over a four-year period. The restricted stock units were originally granted on March 1, 2018 for 85,000 shares. |
6. The option vests over a four-year period, with 1/4th of the shares subject to the option vesting on the one-year anniversary of the vesting commencement date, and 1/48th of the shares subject to the option vesting each month thereafter. |
Remarks: |
/s/ Margaret Tong, Attorney-in-Fact for Chad Summe | 11/29/2018 | |
** 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 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). | ||
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. |