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) 04/20/2021 | 3. Issuer Name and Ticker or Trading Symbol UiPath, Inc. [ PATH ] | |||||||||||||
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) |
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 C-1 Preferred Stock | (1) | (1) | Class A Common Stock | 3,326,970 | (1) | I | By Accel Leaders Fund L.P.(2) |
Series C-2 Preferred Stock | (1) | (1) | Class A Common Stock | 2,657,322 | (1) | I | By Accel Leaders Fund L.P.(2) |
Series D-1 Preferred Stock | (1) | (1) | Class A Common Stock | 747,579 | (1) | I | By Accel Leaders Fund L.P.(2) |
Series D-2 Preferred Stock | (1) | (1) | Class A Common Stock | 125,532 | (1) | I | By Accel Leaders Fund L.P.(2) |
Series E Preferred Stock | (1) | (1) | Class A Common Stock | 25,665 | (1) | I | By Accel Leaders Fund L.P.(2) |
Series C-1 Preferred Stock | (1) | (1) | Class A Common Stock | 158,958 | (1) | I | By Accel Leaders Fund Investors 2016 L.L.C.(3) |
Series C-2 Preferred Stock | (1) | (1) | Class A Common Stock | 126,963 | (1) | I | By Accel Leaders Fund Investors 2016 L.L.C.(3) |
Series D-1 Preferred Stock | (1) | (1) | Class A Common Stock | 35,718 | (1) | I | By Accel Leaders Fund Investors 2016 L.L.C.(3) |
Series D-2 Preferred Stock | (1) | (1) | Class A Common Stock | 5,997 | (1) | I | By Accel Leaders Fund Investors 2016 L.L.C.(3) |
Series E Preferred Stock | (1) | (1) | Class A Common Stock | 1,226 | (1) | I | By Accel Leaders Fund Investors 2016 L.L.C.(3) |
Explanation of Responses: |
1. Each share of Series C-1 Preferred Stock, Series C-2 Preferred Stock, Series D-1 Preferred Stock, Series D-2 Preferred Stock and Series E Preferred Stock will automatically convert into one share of Class A Common Stock immediately prior to the closing of the Issuer's initial public offering (IPO), and has no expiration date. |
2. Accel Leaders Fund Associates L.L.C., or ALFA, is the General Partner of Accel Leaders Fund L.P. and has sole voting and investment power. Andrew G. Braccia, Sameer K. Gandhi, Ping Li, Tracy L. Sedlock, Ryan J. Sweeney, and Richard P. Wong are the Managing Members of ALFA and share such powers. Such Managing Members and the Reporting Person hereunder disclaim beneficial ownership except to the extent of their pecuniary interest therein. |
3. Andrew G. Braccia, Sameer K. Gandhi, Ping Li, Tracy L. Sedlock, Ryan J. Sweeney, and Richard P. Wong are the Managing Members of Accel Leaders Fund Investors 2016 L.L.C. and share voting and investment powers. Such Managing Members and the Reporting Person hereunder disclaim beneficial ownership except to the extent of their pecuniary interest therein. |
Remarks: |
Exhibit 24 - Power of Attorney This Form 3 is the second of two Form 3s filed relating to the same event. Combined, the two reports report the holdings for the Reporting Person, a director of the Issuer and his indirect relationship to the following reporting persons the "Accel Reporting Persons": Accel London V L.P., Accel London V Strategic Partners L.P., Accel London Investors 2016 L.P., Accel London V Associates L.L.C., Accel Growth Fund IV L.P., Accel Growth Fund IV Strategic Partners L.P., Accel Growth Fund IV Associates L.L.C., Accel Growth Fund Investors 2016 L.L.C., Accel Leaders Fund L.P., Accel Leaders Fund Associates L.L.C., Accel Leaders Fund Investors 2016 L.L.C. This Form 3 has been split into two filings because there are more than 30 reportable holdings among the Accel Reporting Persons in total, and the SEC's EDGAR filing system limits a single Form 3 to a maximum of 30 reportable holdings. Each Form 3 is filed by designated filer Exhibit 24 Power of Attorney. |
/s/ Brad Brubaker, Attorney-in-Fact | 04/20/2021 | |
** 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 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. |