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) 04/06/2017 | 3. Issuer Name and Ticker or Trading Symbol Elevate Credit, Inc. [ ELVT ] | |||||||||||||
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 | 14,822(1) | I | TCV V, L.P.(2) |
Common Stock | 286(1) | I | TCV Member Fund, L.P.(3) |
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 | ||||
Series A Preferred Stock | (4) | (4) | Common Stock | 368,215(1) | (4) | I | TCV V, L.P.(2) |
Series A Preferred Stock | (4) | (4) | Common Stock | 7,078(1) | (4) | I | TCV Member Fund, L.P.(3) |
Series B Preferred Stock | (5) | (5) | Common Stock | 1,972,415(1) | (5) | I | TCV V, L.P.(2) |
Series B Preferred Stock | (5) | (5) | Common Stock | 39,348(1) | (5) | I | TCV Member Fund, L.P.(3) |
Restricted Stock Units | (6) | (6) | Common Stock | 2,444(1) | 0 | I | John Rosenberg(7) |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. The number of shares of common stock reported does not reflect a 2.5-for-1 forward stock split, to be effective upon the closing of the issuer's initial public offering. |
2. These securities are directly held by TCV V, L.P. ("TCV V"). Jay C. Hoag, Richard H. Kimball, John L. Drew, and Jon Q. Reynolds are Class A Members (collectively, the "TCM V Members") and John C. Rosenberg is an Assignee of Technology Crossover Management V, L.L.C. ("TCM V") which is the general partner of TCV V. The TCM V Members, Mr. Rosenberg and TCM V may be deemed to beneficially own the securities held by TCV V, but each of the TCM V Members, Mr. Rosenberg and TCM V disclaim beneficial ownership of such securities except to the extent of their pecuniary interest therein. |
3. These securities are directly held by TCV Member Fund, L.P. ("TCV Member Fund"). The TCM V Members are Members and Mr. Rosenberg is an Assignee of TCM V, which is a general partner of TCV Member Fund. The TCM V Members and Mr. Rosenberg are also limited partners of TCV Member Fund. The TCM V Members, Mr. Rosenberg and TCM V may be deemed to beneficially own the securities held by TCV Member Fund, but each of the TCM V Members, Mr. Rosenberg and TCM V disclaim beneficial ownership of such securities except to the extent of their pecuniary interest therein. |
4. The Series A preferred stock is convertible into issuer common stock on a one-for-one basis and has no expiration date. |
5. The Series B preferred stock is convertible into issuer common stock on a one-for-one basis and has no expiration date. |
6. The restricted stock units will vest upon the later of July 1, 2017 or the expiration of the lock-up period following the issuer's initial public offering. If not vested earlier, the restricted stock units will expire on September 21, 2026. |
7. These securities are directly held by John C. Rosenberg. Mr. Rosenberg has sole voting and dispositive power over the securities he holds directly. However, TCV Management 2004, L.L.C. has a right to 100% of the pecuniary interest in such securities. The TCM V Members are members of TCV Management 2004, L.L.C. The TCM V Members each disclaim beneficial ownership of such securities except to the extent of their pecuniary interest therein. |
Remarks: |
By: Frederic D. Fenton, Authorized Signatory for Technology Crossover Management V, L.L.C. | 04/06/2017 | |
By: Frederic D. Fenton, Authorized Signatory for TCV V, L.P. | 04/06/2017 | |
By: Frederic D. Fenton, Authorized Signatory for TCV Member Fund, L.P. | 04/06/2017 | |
By: Frederic D. Fenton, Authorized Signatory for Jay C. Hoag | 04/06/2017 | |
By: Frederic D. Fenton, Authorized Signatory for Richard H. Kimball | 04/06/2017 | |
By: Frederic D. Fenton, Authorized Signatory for John L. Drew | 04/06/2017 | |
By: Frederic D. Fenton, Authorized Signatory for Jon Q. Reynolds | 04/06/2017 | |
By: Frederic D. Fenton, Authorized Signatory for John C. Rosenberg | 04/06/2017 | |
** 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. |