Miura-Ko R. Ann Form 3 Lyft / R. Ann Miura-Ko ownership change

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^*

Miura-Ko R. Ann

(Last)

(First)

(Middle)

C/O FLOODGATE

820 RAMONA STREET, SUITE 200

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
03/28/2019

3. Issuer Name and Ticker or Trading Symbol
Lyft, Inc. [ LYFT ]

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

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

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

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

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

Table I - Non-Derivative Securities Beneficially Owned
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)
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)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	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)
Series Seed Preferred Stock	⁽¹⁾	⁽¹⁾	Common Stock⁽²⁾	1,070,867	⁽¹⁾	I	See Footnote⁽³⁾
Series Seed Preferred Stock	⁽¹⁾	⁽¹⁾	Common Stock⁽²⁾	83,005	⁽¹⁾	I	See Footnote⁽⁴⁾
Series A Preferred Stock	⁽¹⁾	⁽¹⁾	Common Stock⁽²⁾	243,369	⁽¹⁾	I	See Footnote⁽³⁾
Series A Preferred Stock	⁽¹⁾	⁽¹⁾	Common Stock⁽²⁾	18,870	⁽¹⁾	I	See Footnote⁽⁴⁾
Series B Preferred Stock	⁽¹⁾	⁽¹⁾	Common Stock⁽²⁾	110,345	⁽¹⁾	I	See Footnote⁽³⁾
Series B Preferred Stock	⁽¹⁾	⁽¹⁾	Common Stock⁽²⁾	8,561	⁽¹⁾	I	See Footnote⁽⁴⁾

Explanation of Responses:

1. The Series Seed Preferred Stock, Series A Preferred Stock and Series B Preferred Stock shall automatically convert into Common Stock on a 1:1 basis, for no additional consideration, immediately prior to the completion of the Issuer's initial public offering of Class A Common Stock and has no expiration date.

2. Each share of Common Stock shall be reclassified into one share of Class A Common Stock, for no additional consideration, immediately prior to the completion of the Issuer's initial public offering of Class A Common Stock.

3. These shares are held directly by Maples Investments II, L.P. ("MI II"). Maples Management II, L.L.C. ("GP II") is the general partner of MI II and may be deemed to have sole voting and dispositive power over the securities held by MI II. The Reporting Person is a non-managing member of GP II and disclaims beneficial ownership of the securities held by MI II, except to the extent of any pecuniary interest therein.

4. These shares are held directly by Maples Associates II, L.P. ("MA II"). GP II is the general partner of MA II and may be deemed to have sole voting and dispositive power over the securities held by MA II. The Reporting Person is a non-managing member of GP II and disclaims beneficial ownership of the securities held by MA II, except to the extent of any pecuniary interest therein.

Remarks:

Exhibit 24 - Power of Attorney

	/s/ David Le, by power of attorney	03/28/2019
	** 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.

Miura-Ko R. Ann Form 3Lyft / R. Ann Miura-Ko ownership change