Coupa Software (COUP) Form 4 Coupa Software / William W. Ericson ownership change

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^*

MDV IX LP

(Last) (First) (Middle)

777 MARINERS ISLAND BLVD.

SUITE 550

(Street)

SAN MATEO CA 94404

(City) (State) (Zip)

2. Issuer Name and Ticker or Trading Symbol
Coupa Software Inc [ COUP ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

Director	X	10% Owner
Officer (give title below)		Other (specify below)

3. Date of Earliest Transaction (Month/Day/Year)
10/12/2016

4. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

	Form filed by One Reporting Person
X	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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	10/12/2016		C		6,648,700	A	(1)	6,648,700	I	MDV IX, L.P., as nominee for MDV IX, L.P., and MDV ENF IX, L.P.(2)

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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 D Convertible Preferred Stock	$1.3524	10/12/2016	(1)	C			5,546,449	(1)	(1)	Common Stock	5,546,449	(1)	0	I	MDV IX, L.P., as nominee for MDV IX, L.P., and MDV ENF IX, L.P.(2)
Series E Convertible Preferred Stock	$3.1148	10/12/2016	(1)	C			1,015,725	(1)	(1)	Common Stock	1,015,725	(1)	0	I	MDV IX, L.P., as nominee for MDV IX, L.P., and MDV ENF IX, L.P.(2)
Series F Convertible Preferred Stock	$8.09	10/12/2016	(1)	C			86,526	(1)	(1)	Common Stock	86,526	(1)	0	I	MDV IX, L.P., as nominee for MDV IX, L.P., and MDV ENF IX, L.P.(2)

1. Name and Address of Reporting Person^*

MDV IX LP

(Last) (First) (Middle)

777 MARINERS ISLAND BLVD.

SUITE 550

(Street)

SAN MATEO CA 94404

(City) (State) (Zip)

1. Name and Address of Reporting Person^*

Ninth MDV Partners, L.L.C.

(Last) (First) (Middle)

777 MARINERS ISLAND BLVD.

SUITE 550

(Street)

SAN MATEO CA 94404

(City) (State) (Zip)

1. Name and Address of Reporting Person^*

FEIBER JONATHAN D

(Last) (First) (Middle)

777 MARINERS ISLAND BLVD.

SUITE 550

(Street)

SAN MATEO CA 94404

(City) (State) (Zip)

1. Name and Address of Reporting Person^*

Ericson William W.

(Last) (First) (Middle)

777 MARINERS ISLAND BLVD.

SUITE 550

(Street)

SAN MATEO CA 94404

(City) (State) (Zip)

Explanation of Responses:

1. Each share of Series D Convertible Preferred Stock, Series E Convertible Preferred Stock and Series F Convertible Preferred Stock automatically converted into one share of Issuer's Common Stock for no additional consideration immediately prior to the completion of the Issuer's initial public offering. The exercisability date and expiration date are not relevant to the conversion of these securities.

2. Ninth MDV Partners, L.L.C. is the general partner of MDV IX, L.P., as nominee for MDV IX, L.P. and MDV ENF IX, L.P. (collectively, "MDV IX"). William Ericson ("Ericson") and Jonathan Feiber ("Feiber") are Managing Members of Ninth MDV Partners, L.L.C. Ericson and Feiber may be deemed to share voting and dispositive power over the shares held by MDV IX and disclaim beneficial ownership of the shares held by MDV IX except to the extent of their pecuniary interest therein.

Remarks:

	/s/ Brett Teele	10/14/2016
	** 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).
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