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 |
|
1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 11/01/2020 | 3. Issuer Name and Ticker or Trading Symbol SERVICESOURCE INTERNATIONAL, INC. [ SREV ] | |||||||||||||
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)
|
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) |
Common Stock | 282,908(1) | D |
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) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Employee Stock Option (right to buy) | (2) | 05/05/2026 | Common Stock | 110,000 | 3.9 | D | |
Employee Stock Option (right to buy) | (3) | 09/01/2029 | Common Stock | 150,000 | 0.92 | D |
Explanation of Responses: |
1. The reported shares are represented by common stock held and restricted stock units (RSUs). On September 1, 2019, 200,000 RSUs were granted and one third vested on September 1, 2020 and 42,792 shares of common stock were subsequently delivered to the Reporting Person and 23,875 were withheld to satisfy the Reporting Person's tax liability in connection with the vesting of RSUs. The remaining RSUs from the September 1, 2019 grant are scheduled to vest in two equal installments on September 1, 2021 and September 1, 2022. On September 1, 2020, 100,000 RSUs were granted and vest in three equal installments on September 1, 2021, September 1, 2022, and September 1, 2023. The Reporting Person holds 49,575 shares of common stock. |
2. One-fourth of the shares subject to the option vested on May 5, 2017 and one thirty-sixth of the remaining shares subject to the option vested monthly thereafter. |
3. One-third of the shares subject to the option vested on September 1, 2020 and one twenty-fourth of the remaining shares subject to the option vest monthly thereafter. |
Remarks: |
/s/ Patricia A. Elias, by power of attorney | 11/09/2020 | |
** 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. |