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) 12/11/2019 | 3. Issuer Name and Ticker or Trading Symbol Bill.com Holdings, Inc. [ BILL ] | |||||||||||||
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 B Convertible Preferred Stock | (1) | (1) | Common Stock | 102,739 | 0 | I | See Footnote(2) |
Series C Convertible Preferred Stock | (1) | (1) | Common Stock | 2,407,487 | 0 | I | See Footnote(2) |
Series D Convertible Preferred Stock | (1) | (1) | Common Stock | 417,081 | 0 | I | See Footnote(2) |
Series E Convertible Preferred Stock | (1) | (1) | Common Stock | 373,134 | 0 | I | See Footnote(2) |
Series F Convertible Preferred Stock | (1) | (1) | Common Stock | 81,983 | 0 | I | See Footnote(2) |
Series G Convertible Preferred Stock | (1) | (1) | Common Stock | 51,187 | 0 | I | See Footnote(2) |
Explanation of Responses: |
1. The shares of Convertible Preferred Stock are convertible into the Issuer's Common Stock on a 1:1 basis and have no expiration date. Immediately upon the close of the Issuer's initial public offering all shares of convertible preferred stock will be automatically converted into shares of Common Stock. |
2. The shares are held by Icon Ventures IV, L.P. Icon Management Associates IV, LLC is the general partner of Icon Ventures IV, L.P. Joseph Horowitz, Thomas Mawhinney, a member of the Issuer's board of directors, and Jeb Miller are the managing members of Icon Management Associates IV, LLC and share voting and dispositive control with respect to the shares held by Icon Ventures IV, L.P. |
Remarks: |
Exhibit 24.1 - Power of Attorney |
/s/ Rajesh Aji, Attorney-in-Fact | 12/11/2019 | |
** 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. |