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) 07/24/2019 | 3. Issuer Name and Ticker or Trading Symbol Health Catalyst, Inc. [ HCAT ] | |||||||||||||
| 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 A Preferred Stock | (1) | (1) | Common Stock | 3,436,107 | (1) | I | Sequoia Capital U.S. Growth Fund IV, L.P.(2) |
| Series A Preferred Stock | (1) | (1) | Common Stock | 151,392 | (1) | I | Sequoia Capital USGF Principals Fund IV, L.P.(2) |
| Series B Preferred Stock | (3) | (3) | Common Stock | 731,890 | (3) | I | Sequoia Capital U.S. Growth Fund IV, L.P.(2) |
| Series B Preferred Stock | (3) | (3) | Common Stock | 32,246 | (3) | I | Sequoia Capital USGF Principals Fund IV, L.P.(2) |
| Series C Preferred Stock | (4) | (4) | Common Stock | 1,474,068 | (4) | I | SC US GF V Holdings, Ltd.(5) |
| Series D Preferred Stock | (6) | (6) | Common Stock | 176,222 | (6) | I | Sequoia Capital U.S. Growth Fund IV, L.P.(2) |
| Series D Preferred Stock | (6) | (6) | Common Stock | 59,693 | (6) | I | Sequoia Capital U.S. Growth Fund V, L.P.(5) |
| Series E Preferred Stock | (7) | (7) | Common Stock | 60,463 | (7) | I | Sequoia Capital U.S. Growth Fund IV, L.P.(2) |
| Series E Preferred Stock | (7) | (7) | Common Stock | 20,381 | (7) | I | Sequoia Capital U.S. Growth Fund V, L.P.(5) |
| Series F Preferred Stock | (8) | (8) | Common Stock | 26,831 | (8) | I | Sequoia Capital U.S. Growth Fund IV, L.P.(2) |
| Series F Preferred Stock | (8) | (8) | Common Stock | 9,088 | (8) | I | Sequoia Capital U.S. Growth Fund V, L.P.(5) |
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. Each share of Series A Preferred Stock is convertible on a one-for-one basis into the number of shares of the Issuer's common stock shown in column 3 at any time at the holder's election and automatically upon the closing of the Issuer's initial public offering. The Series A Preferred Stock has no expiration date. |
| 2. SC US (TTGP), Ltd. is the general partner of SCGF IV Management, L.P., which is the general partner of Sequoia Capital U.S. Growth Fund IV, LP and Sequoia Capital USGF Principals Fund IV, LP (collectively, the "SC USGF IV Funds"). As a result, SC US (TTGP), Ltd. and SCGF IV Management, L.P. may be deemed to share voting and dispositive power with respect to the shares held by the SC USGF IV Funds. Each of SC US (TTGP), Ltd. and SCGF IV Management, L.P. disclaims beneficial ownership of the shares held by the SC USGF IV Funds, except to the extent of its pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes. |
| 3. Each share of Series B Preferred Stock is convertible on a one-for-one basis into the number of shares of the Issuer's common stock shown in column 3 at any time at the holder's election and automatically upon the closing of the Issuer's initial public offering. The Series B Preferred Stock has no expiration date. |
| 4. Each share of Series C Preferred Stock is convertible on a one-for-one basis into the number of shares of the Issuer's common stock shown in column 3 at any time at the holder's election and automatically upon the closing of the Issuer's initial public offering. The Series C Preferred Stock has no expiration date. |
| 5. SC US (TTGP), Ltd. is the general partner of SCGF V Management, L.P., which is the general partner of Sequoia Capital U.S. Growth Fund V, LP ("SC USGF V") and Sequoia Capital USGF Principals Fund V, L.P. (together, the "SC USGF V Funds"), which together own 100% of the outstanding shares of SC US GF V Holdings, Ltd ("SC USGF V Holdco"). As a result, SC US (TTGP), Ltd. and SCGF V Management, L.P. may be deemed to share voting and dispositive power with respect to the shares held by the SC USGF V Funds and SC USGF V Holdco. Each of SC US (TTGP), Ltd. and SCGF V Management, L.P. disclaims beneficial ownership of the shares held by the SC USGF V Funds, except to the extent of its pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes. |
| 6. Each share of Series D Preferred Stock is convertible on a one-for-one basis into the number of shares of the Issuer's common stock shown in column 3 at any time at the holder's election and automatically upon the closing of the Issuer's initial public offering. The Series D Preferred Stock has no expiration date. |
| 7. Each share of Series E Preferred Stock is convertible on a one-for-one basis into the number of shares of the Issuer's common stock shown in column 3 at any time at the holder's election and automatically upon the closing of the Issuer's initial public offering. The Series E Preferred Stock has no expiration date. |
| 8. Each share of Series F Preferred Stock is convertible on a one-for-one basis into the number of shares of the Issuer's common stock shown in column 3 at any time at the holder's election and automatically upon the closing of the Issuer's initial public offering. The Series F Preferred Stock has no expiration date. |
| Remarks: |
| Exhibit 24 - Power of Attorney /s/ Jung Yeon Son, by Power of Attorney for Douglas Leone, a Director of SC US (TTGP), Ltd., General Partner of SCGF V Management, L.P., General Partner of Sequoia Capital U.S. Growth Fund V, L.P. and Sequoia Capital USGF Principals Fund V, L.P., which together own 100% of SC US GF V Holdings, Ltd. |
| /s/ Jung Yeon Son, by power of attorney for Douglas Leone, a Director of SC US (TTGP), Ltd. | 07/24/2019 | |
| /s/ Jung Yeon Son, by Power of Attorney for Douglas Leone, a Director of SC US (TTGP), Ltd., General Partner of SCGF V Management, L.P. | 07/24/2019 | |
| /s/ Jung Yeon Son, by Power of Attorney for Douglas Leone, a Director of SC US (TTGP), Ltd., General Partner of SCGF IV Management, L.P. | 07/24/2019 | |
| /s/ Jung Yeon Son, by Power of Attorney for Douglas Leone, a Director of SC US (TTGP), Ltd., General Partner of SCGF V Management, L.P., General Partner of each of Sequoia Capital U.S. Growth Fund V, L.P. and Sequoia Capital USGF Principals Fund V, L.P. | 07/24/2019 | |
| See Remarks | 07/24/2019 | |
| /s/ Jung Yeon Son, by Power of Attorney for Douglas Leone, a Director of SC US (TTGP), Ltd., General Partner of SCGF IV Management, L.P., General Partner of Sequoia Capital U.S. Growth Fund IV, LP. and Sequoia Capital USGF Principals Fund IV, LP. | 07/24/2019 | |
| ** 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. | ||