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)
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2. Issuer Name and Ticker or Trading Symbol
Maplebear Inc. [ CART ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 09/21/2023 | ||||||||||||||||||||||||||
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 | 09/21/2023 | C | 2,565,244 | A | (1) | 4,405,162 | I | Sequoia Capital Global Growth Fund II, L.P.(2)(3)(4) | ||
Common Stock | 09/21/2023 | C | 39,670 | A | (1) | 68,020 | I | Sequoia Capital Global Growth II Principals Fund, L.P.(2)(3)(4) | ||
Common Stock | 09/21/2023 | C | 351,374 | A | (1) | 351,374 | I | Sequoia Capital Global Growth Fund III - Endurance Partners, L.P.(2)(3)(4) | ||
Common Stock | 09/21/2023 | C | 25,726,519 | A | (1) | 25,726,519 | I | Sequoia Capital USV XIV Holdco, Ltd.(2)(3)(4) | ||
Common Stock | 09/21/2023 | C | 4,744,206 | A | (1) | 4,744,206 | I | Sequoia Capital U.S. Growth Fund VI, L.P.(2)(3)(4) | ||
Common Stock | 09/21/2023 | C | 308,013 | A | (1) | 308,013 | I | Sequoia Capital U.S. Growth VI Principals Fund, L.P.(2)(3)(4) | ||
Common Stock | 09/21/2023 | C | 1,774,756 | A | (1) | 1,774,756 | I | Sequoia Capital U.S. Growth Fund VII, L.P.(2)(3)(4) | ||
Common Stock | 09/21/2023 | C | 164,955 | A | (1) | 164,955 | I | Sequoia Capital U.S. Growth VII Principals Fund, L.P.(2)(3)(4) | ||
Common Stock | 09/21/2023 | C | 14,185 | A | (1) | 14,185 | I | Sequoia Grove UK, L.P.(5) | ||
Common Stock | 09/21/2023 | C | 11,937,988 | A | (1) | 12,393,305 | I | Sequoia Grove II, LLC(5) | ||
Common Stock | 09/21/2023 | P | 1,000,000 | A | $30 | 1,000,000 | I | Sequoia Capital US/E Expansion Fund I, L.P.(2)(3)(4) | ||
Common Stock | 1,217,532 | I | SCGGF III - U.S./India Management, L.P.(2)(3)(4) |
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 A Preferred Stock | (1) | 09/21/2023 | C | 29,655 | (1) | (1) | Common Stock | 29,655 | $0 | 0 | I | Sequoia Capital Global Growth Fund III - Endurance Partners, L.P.(2)(3)(4) | |||
Series A Preferred Stock | (1) | 09/21/2023 | C | 25,372,460 | (1) | (1) | Common Stock | 25,372,460 | $0 | 0 | I | Sequoia Capital USV XIV Holdco, Ltd.(2)(3)(4) | |||
Series A Preferred Stock | (1) | 09/21/2023 | C | 8,328,209 | (1) | (1) | Common Stock | 8,328,209 | $0 | 0 | I | Sequoia Grove II, LLC(5) | |||
Series A Preferred Stock | (1) | 09/21/2023 | C | 117 | (1) | (1) | Common Stock | 117 | $0 | 0 | I | Sequoia Grove UK, L.P.(5) | |||
Series B Preferred Stock | (1) | 09/21/2023 | C | 2,730,563 | (1) | (1) | Common Stock | 2,730,563 | $0 | 0 | I | Sequoia Capital U.S. Growth Fund VI, L.P.(2)(3)(4) | |||
Series B Preferred Stock | (1) | 09/21/2023 | C | 195,343 | (1) | (1) | Common Stock | 195,343 | $0 | 0 | I | Sequoia Capital U.S. Growth VI Principals Fund, L.P.(2)(3)(4) | |||
Series B Preferred Stock | (1) | 09/21/2023 | C | 258,964 | (1) | (1) | Common Stock | 258,964 | $0 | 0 | I | Sequoia Capital USV XIV Holdco, Ltd.(2)(3)(4) | |||
Series B Preferred Stock | (1) | 09/21/2023 | C | 1,254,314 | (1) | (1) | Common Stock | 1,254,314 | $0 | 0 | I | Sequoia Grove II, LLC(5) | |||
Series C Preferred Stock | (1) | 09/21/2023 | C | 1,452,690 | (1) | (1) | Common Stock | 1,452,690 | $0 | 0 | I | Sequoia Capital U.S. Growth Fund VI, L.P.(2)(3)(4) | |||
Series C Preferred Stock | (1) | 09/21/2023 | C | 103,925 | (1) | (1) | Common Stock | 103,925 | $0 | 0 | I | Sequoia Capital U.S. Growth VI Principals Fund, L.P.(2)(3)(4) | |||
Series C Preferred Stock | (1) | 09/21/2023 | C | 56,571 | (1) | (1) | Common Stock | 56,571 | $0 | 0 | I | Sequoia Capital USV XIV Holdco, Ltd.(2)(3)(4) | |||
Series C Preferred Stock | (1) | 09/21/2023 | C | 640,679 | (1) | (1) | Common Stock | 640,679 | $0 | 0 | I | Sequoia Grove II, LLC(5) | |||
Series D Preferred Stock | (1) | 09/21/2023 | C | 2,565,244 | (1) | (1) | Common Stock | 2,565,244 | $0 | 0 | I | Sequoia Capital Global Growth Fund II, L.P.(2)(3)(4) | |||
Series D Preferred Stock | (1) | 09/21/2023 | C | 39,670 | (1) | (1) | Common Stock | 39,670 | $0 | 0 | I | Sequoia Capital Global Growth II Principals Fund, L.P.(2)(3)(4) | |||
Series D Preferred Stock | (1) | 09/21/2023 | C | 560,953 | (1) | (1) | Common Stock | 560,953 | $0 | 0 | I | Sequoia Capital U.S. Growth Fund VI, L.P.(2)(3)(4) | |||
Series D Preferred Stock | (1) | 09/21/2023 | C | 8,745 | (1) | (1) | Common Stock | 8,745 | $0 | 0 | I | Sequoia Capital U.S. Growth VI Principals Fund, L.P.(2)(3)(4) | |||
Series D Preferred Stock | (1) | 09/21/2023 | C | 1,774,756 | (1) | (1) | Common Stock | 1,774,756 | $0 | 0 | I | Sequoia Capital U.S. Growth Fund VII, L.P.(2)(3)(4) | |||
Series D Preferred Stock | (1) | 09/21/2023 | C | 164,955 | (1) | (1) | Common Stock | 164,955 | $0 | 0 | I | Sequoia Capital U.S. Growth VII Principals Fund, L.P.(2)(3)(4) | |||
Series D Preferred Stock | (1) | 09/21/2023 | C | 38,524 | (1) | (1) | Common Stock | 38,524 | $0 | 0 | I | Sequoia Capital USV XIV Holdco, Ltd.(2)(3)(4) | |||
Series D Preferred Stock | (1) | 09/21/2023 | C | 1,637,777 | (1) | (1) | Common Stock | 1,637,777 | $0 | 0 | I | Sequoia Grove II, LLC(5) | |||
Series D Preferred Stock | (1) | 09/21/2023 | C | 12,796 | (1) | (1) | Common Stock | 12,796 | $0 | 0 | I | Sequoia Grove UK, L.P.(5) | |||
Series I Preferred Stock | (1) | 09/21/2023 | C | 321,719 | (1) | (1) | Common Stock | 321,719 | $0 | 0 | I | Sequoia Capital Global Growth Fund III - Endurance Partners, L.P.(2)(3)(4) | |||
Series I Preferred Stock | (1) | 09/21/2023 | C | 77,009 | (1) | (1) | Common Stock | 77,009 | $0 | 0 | I | Sequoia Grove II, LLC(5) | |||
Series I Preferred Stock | (1) | 09/21/2023 | C | 1,272 | (1) | (1) | Common Stock | 1,272 | $0 | 0 | I | Sequoia Grove UK, 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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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. The Series A Preferred Stock, Series C Preferred Stock, Series D Preferred Stock and Series I Preferred Stock converted into common stock on a 1:1 basis and the Series B Preferred Stock converted into shares of common stock on a 1.024566722:1 basis, immediately prior to the closing of the Issuer's initial public offering, and had no expiration date. |
2. SC US (TTGP), Ltd. is (i) the general partner of SC U.S. Venture XIV Management, L.P., which is the general partner of each of Sequoia Capital U.S. Venture Fund XIV, L.P., Sequoia Capital U.S. Venture Partners Fund XIV, L.P., and Sequoia Capital U.S. Venture Partners Fund XIV (Q), L.P., or collectively, the XIV Funds, which together own 100% of the outstanding ordinary shares of Sequoia Capital USV XIV Holdco, Ltd., or XIV Holdco; (ii) the general partner of SC U.S. Growth VI Management, L.P., which is the general partner of each of Sequoia Capital U.S. Growth Fund VI, L.P., and Sequoia Capital U.S. Growth VI Principals Fund, L.P., or collectively, the GF VI Funds; (iii) the general partner of SC U.S. Growth VII Management, L.P., which is the general partner of each of Sequoia Capital U.S. Growth Fund VII, L.P., and Sequoia Capital U.S. Growth VII Principals Fund, L.P., or collectively, the GF VII Funds; |
3. (Continue from Footnote 2) (iv) the general partner of SC Global Growth II Management, L.P., which is the general partner of each of Sequoia Capital Global Growth Fund II, L.P., and Sequoia Capital Global Growth II Principals Fund, L.P., or collectively, the GGF II Funds; (v) the general partner of SCGGF III - Endurance Partners Management, L.P., which is the general partner of Sequoia Capital Global Growth Fund III - Endurance Partners, L.P., or GGF III; (vi) the general partner of SCGGF III - U.S./India Management, L.P., or GGF III US IND MGMT; and (vi) the general partner of SC US/E Expansion Fund I Management, L.P., which is the general partner of Sequoia Capital US/E Expansion Fund I, L.P., or EXP I. As a result, SC US (TTGP), Ltd. may be deemed to share voting and dispositive power with respect to the shares held by XIV Holdco, the GF VI Funds, the GF VII Funds, the GGF II Funds, GGF III, GGFIII US IND MGMT and EXP I. |
4. (Continue from Footnote 3) The directors and stockholders of SC US (TTGP), Ltd. who exercise voting and investment discretion with respect to the GGF II Funds, GGF III, and GGF III US IND MGMT are Douglas M. Leone and Roelof Botha. As a result, and by virtue of the relationships described in this paragraph, each such person may be deemed to share voting and dispositive power with respect to the shares held by the GGF II Funds, GGF III, and GGF III US INDMGMT. Each of the reporting persons disclaims beneficial ownership of the shares held by XIV Holdco, the GF VI Funds, the GF VII Funds, the GGF II Funds, GGF III, GGF III US IND MGMT and EXP I, as applicable, except to the extent of his or 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. |
5. Sequoia Grove Manager, LLC is the manager of Sequoia Grove II, LLC and the general partner of Sequoia Grove UK, L.P. As a result, Sequoia Grove Manager, LLC may be deemed to share beneficial ownership with respect to the shares held by Sequoia Grove II, LLC and Sequoia Grove UK, L.P. Each of Sequoia Grove Manager, LLC, Sequoia Grove II, LLC, and Sequoia Grove UK, L.P disclaims beneficial ownership of the shares held by Sequoia Grove II, LLC and Sequoia Grove UK, L.P., as applicable, 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 purpose. |
Remarks: |
Form 1 of 3 |
By: /s/ Jung Yeon Son, by power of attorney for Roelof Botha, a Director of SC US (TTGP), Ltd. | 09/22/2023 | |
By: /s/ Jung Yeon Son, by power of attorney for Roelof Botha, a Director of Sequoia Capital Global Growth II Management, L.P. | 09/22/2023 | |
By: /s/ Jung Yeon Son, by power of attorney for Roelof Botha, a Director of Sequoia Capital Global Growth II Management, L.P., the General Partner of Sequoia Capital Global Growth Fund II, L.P. | 09/22/2023 | |
By: /s/ Jung Yeon Son, by power of attorney for Roelof Botha, a Director of Sequoia Capital Global Growth II Management, L.P., the General Partner of Sequoia Capital Global Growth II Principals Fund, L.P. | 09/22/2023 | |
By: /s/ Jung Yeon Son, by power of attorney for Roelof Botha, a Director of SCGGF III - U.S./India Management, L.P. | 09/22/2023 | |
By: /s/ Jung Yeon Son, by power of attorney for Roelof Botha, a Director of SCGGF III - Endurance Partners Management, L.P | 09/22/2023 | |
By: /s/ Jung Yeon Son, by power of attorney for Roelof Botha, a Director of SCGGF III - Endurance Partners Management, L.P, the General Partner of Sequoia Capital Global Growth Fund III - Endurance Partners, L.P. | 09/22/2023 | |
By: /s/ Jung Yeon Son, by power of attorney for Roelof Botha, a Director of SC U.S. Venture XIV Management, L.P. | 09/22/2023 | |
By: /s/ Jung Yeon Son, by power of attorney for Roelof Botha, a Director of SC U.S. Venture XIV Management, L.P., the General Partner of Sequoia Capital U.S. Venture Fund XIV, L.P. | 09/22/2023 | |
By: /s/ Jung Yeon Son, by power of attorney for Roelof Botha, a Director of SC U.S. Venture XIV Management, L.P., the General Partner of Sequoia Capital U.S. Venture Partners Fund XIV, L.P. | 09/22/2023 | |
** 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. |