| 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) 07/27/2016 | 3. Issuer Name and Ticker or Trading Symbol TACTILE SYSTEMS TECHNOLOGY INC [ TCMD ] | |||||||||||||
| 4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) 07/27/2016 | ||||||||||||||
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 | 201,482 | D | |
| 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) | (2) | Common Stock | 27,969 | (1) | D | |
| Employee Stock Option (Right to Buy) | (3) | 02/26/2018 | Common Stock | 138,294 | 0.51 | D | |
| Employee Stock Option (Right to Buy) | (3) | 06/04/2019 | Common Stock | 35,460 | 0.51 | D | |
| Employee Stock Option (Right to Buy) | (3) | 03/08/2020 | Common Stock | 46,098 | 0.73 | D | |
| Employee Stock Option (Right to Buy) | (3) | 04/20/2021 | Common Stock | 78,366 | 1.55 | D | |
| Employee Stock Option (Right to Buy) | (4) | 10/13/2023 | Common Stock | 177,300 | 0.96 | D | |
| Explanation of Responses: |
| 1. Each share of Series A Preferred Stock is convertible at any time at the option of the holder, and will convert automatically into shares of the Issuer's Common Stock on a one for 1.027 basis in connection with the closing of the Issuer's initial public offering. In addition, the holder is entitled to receive additional shares of common stock equal to the original purchase price per share ($4.2301) divided by the price to the public of the shares of common stock issued in the Issuer's initial public offering. |
| 2. The securities do not have an expiration date. The securities convert automatically into shares of the Issuer's Common Stock in connection with the closing of the Issuer's initial public offering. |
| 3. This option is fully vested. |
| 4. This option vests as follows: 44,325 shares vested on October 9, 2014, and the remaining shares vest as to 3,693 shares each month commencing on November 9, 2014 and continuing until this option is fully vested. |
| /s/ Jonathan R. Zimmerman, Attorney-in-Fact | 08/19/2016 | |
| ** 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 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. | ||
