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 Invuity, Inc. [ IVTY ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 06/18/2015 | ||||||||||||||||||||||||||
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 | ||||||
Common Stock | 06/18/2015 | C | 414,047 | A | (1) | 414,047 | I | See Footnotes(2)(3) | ||
Common Stock | 06/18/2015 | C | 320,389 | A | (4) | 734,436 | I | See Footnotes(2)(5) | ||
Common Stock | 06/18/2015 | C | 207,955 | A | (6) | 942,391 | I | See Footnotes(2)(7) | ||
Common Stock | 06/18/2015 | C | 19,308 | A | (8) | 961,699 | I | See Footnotes(2)(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 | ||||||||
Series B Preferred Stock | (1) | 06/18/2015 | C | 348,585 | (1) | (1) | Common Stock | 414,047 | $0.00 | 0 | I | See Footnotes(2)(10) | |||
Series C Preferred Stock | (4) | 06/18/2015 | C | 301,180 | (4) | (4) | Common Stock | 320,389 | $0.00 | 0 | I | See Footnotes(2)(11) | |||
Series D Preferred Stock | (6) | 06/18/2015 | C | 206,137 | (6) | (6) | Common Stock | 207,955 | $0.00 | 0 | I | See Footnotes(2)(12) | |||
Series E Preferred Stock | (8) | 06/18/2015 | C | 18,789 | (8) | (8) | Common Stock | 19,308 | $0.00 | 0 | I | See Footnotes(2)(13) |
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. 348,585 outstanding shares of Series B Preferred Stock automatically converted into 414,047 shares of Common Stock, on a 1.18779522532874 -for-one basis, immediately prior to the closing of the Issuer's initial public offering of Common Stock and had no expiration date. |
2. The managing member of Kleiner Perkins Caufield & Byers XII, LLC ("KPCB XII") and KPCB XII Founders Fund, LLC ("KPCB XII Founders") is KPCB XII Associates, LLC ("XII Associates"). The voting and dispositive control over the shares is shared by individual managing directors of XII Associates, none of whom has veto power. |
3. KPCB XII owns 368,336 shares. KPCB XII Founders owns 7,039 shares. Excludes 38,672 shares in the aggregate beneficially owned by individuals and entities associated with Kleiner Perkins Caufield & Byers and held for convenience in the name of "KPCB Holdings, Inc. as nominee" for the accounts of such individuals and entities who each exercise their own voting and dispositive control over such shares. |
4. 301,180 outstanding shares of Series C Preferred Stock automatically converted into 320,389 shares of Common Stock, on a 1.06378132118451-for-one basis, immediately prior to the closing of the Issuer's initial public offering of Common Stock and had no expiration date. |
5. KPCB XII owns 655,149 shares. KPCB XII Founders owns 10,691 shares. Excludes 68,596 shares in the aggregate beneficially owned by individuals and entities associated with Kleiner Perkins Caufield & Byers and held for convenience in the name of "KPCB Holdings, Inc. as nominee" for the accounts of such individuals and entities who each exercise their own voting and dispositive control over such shares. |
6. 206,137 outstanding shares of Series D Preferred Stock automatically converted into 207,955 shares of Common Stock, on a 1.008821799-for-one basis, immediately prior to the closing of the Issuer's initial public offering of Common Stock and had no expiration date. |
7. KPCB XII owns 841,311 shares. KPCB XII Founders owns 13,061 shares. Excludes 88,019 shares in the aggregate beneficially owned by individuals and entities associated with Kleiner Perkins Caufield & Byers and held for convenience in the name of "KPCB Holdings, Inc. as nominee" for the accounts of such individuals and entities who each exercise their own voting and dispositive control over such shares. |
8. 18,789 outstanding shares of Series E Preferred Stock automatically converted into 19,308 shares of Common Stock, on a 1.027662672-for-one basis, immediately prior to the closing of the Issuer's initial public offering of Common Stock and had no expiration date. |
9. KPCB XII owns 858,597 shares. KPCB XII Founders owns 13,280 shares. Excludes 89,822 shares in the aggregate beneficially owned by individuals and entities associated with Kleiner Perkins Caufield & Byers and held for convenience in the name of "KPCB Holdings, Inc. as nominee" for the accounts of such individuals and entities who each exercise their own voting and dispositive control over such shares. |
10. KPCB XII owns 310,101 shares. KPCB XII Founders owns 5,926 shares. Excludes 32,558 shares in the aggregate beneficially owned by individuals and entities associated with Kleiner Perkins Caufield & Byers and held for convenience in the name of "KPCB Holdings, Inc. as nominee" for the accounts of such individuals and entities who each exercise their own voting and dispositive control over such shares. |
11. KPCB XII owns 269,617 shares. KPCB XII Founders owns 3,433 shares. Excludes 28,130 shares in the aggregate beneficially owned by individuals and entities associated with Kleiner Perkins Caufield & Byers and held for convenience in the name of "KPCB Holdings, Inc. as nominee" for the accounts of such individuals and entities who each exercise their own voting and dispositive control over such shares. |
12. KPCB XII owns 184,534 shares. KPCB XII Founders owns 2,350 shares. Excludes 19,253 shares in the aggregate beneficially owned by individuals and entities associated with Kleiner Perkins Caufield & Byers and held for convenience in the name of "KPCB Holdings, Inc. as nominee" for the accounts of such individuals and entities who each exercise their own voting and dispositive control over such shares. |
13. KPCB XII owns 16,820 shares. KPCB XII Founders owns 214 shares. Excludes 1,755 shares in the aggregate beneficially owned by individuals and entities associated with Kleiner Perkins Caufield & Byers and held for convenience in the name of "KPCB Holdings, Inc. as nominee" for the accounts of such individuals and entities who each exercise their own voting and dispositive control over such shares. |
Remarks: |
The Reporting Persons disclaim beneficial ownership of these shares except to the extent of any pecuniary interest therein, and the filing of this report is not an admission that the Reporting Persons are the beneficial owners of these shares for purposes of Section 16 or for any other purpose. |
/s/ Paul Vronsky, General Counsel | 06/22/2015 | |
/s/ Paul Vronsky, General Counsel | 06/22/2015 | |
/s/ Paul Vronsky, General Counsel | 06/22/2015 | |
** 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. |