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) 06/25/2015 | 3. Issuer Name and Ticker or Trading Symbol Xactly Corp [ XTLY ] | |||||||||||||
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 A Convertible Preferred Stock | (1) | (1) | Common Stock | 938,323 | (1) | I | See footnote(2) |
Series A Convertible Preferred Stock | (1) | (1) | Common Stock | 5,894 | (1) | I | See footnote(3) |
Series A Convertible Preferred Stock | (1) | (1) | Common Stock | 17 | (1) | I | See footnote(4) |
Series A Convertible Preferred Stock | (1) | (1) | Common Stock | 42,758 | (1) | I | See footnote(5) |
Series A Convertible Preferred Stock | (1) | (1) | Common Stock | 21,379 | (1) | I | See footnote(6) |
Series B Convertible Preferred Stock | (7) | (7) | Common Stock | 370,325 | (7) | I | See footnote(2) |
Series B Convertible Preferred Stock | (7) | (7) | Common Stock | 72,589 | (7) | I | See footnote(3) |
Series B Convertible Preferred Stock | (7) | (7) | Common Stock | 217 | (7) | I | See footnote(4) |
Series B Convertible Preferred Stock | (7) | (7) | Common Stock | 29,598 | (7) | I | See footnote(5) |
Series B Convertible Preferred Stock | (7) | (7) | Common Stock | 14,799 | (7) | I | See footnote(6) |
Series C Convertible Preferred Stock | (8) | (8) | Common Stock | 209,761 | (8) | I | See footnote(2) |
Series C Convertible Preferred Stock | (8) | (8) | Common Stock | 130,990 | (8) | I | See footnote(3) |
Series C Convertible Preferred Stock | (8) | (8) | Common Stock | 393 | (8) | I | See footnote(4) |
Series C Convertible Preferred Stock | (8) | (8) | Common Stock | 14,764 | (8) | I | See footnote(5) |
Series D Convertible Preferred Stock | (9) | (9) | Common Stock | 295,919 | (9) | I | See footnote(2) |
Series D Convertible Preferred Stock | (9) | (9) | Common Stock | 603,313 | (9) | I | See footnote(3) |
Series D Convertible Preferred Stock | (9) | (9) | Common Stock | 1,815 | (9) | I | See footnote(4) |
Series D Convertible Preferred Stock | (9) | (9) | Common Stock | 13,157 | (9) | I | See footnote(5) |
Series D Convertible Preferred Stock | (9) | (9) | Common Stock | 6,578 | (9) | I | See footnote(6) |
Series D-1 Convertible Preferred Stock | (10) | (10) | Common Stock | 45,908 | (10) | I | See footnote(2) |
Series D-1 Convertible Preferred Stock | (10) | (10) | Common Stock | 93,596 | (10) | I | See footnote(3) |
Series D-1 Convertible Preferred Stock | (10) | (10) | Common Stock | 281 | (10) | I | See footnote(4) |
Series D-1 Convertible Preferred Stock | (10) | (10) | Common Stock | 14,544 | (10) | I | See footnote(5) |
Series D-1 Convertible Preferred Stock | (10) | (10) | Common Stock | 6,201 | (10) | I | See footnote(6) |
Series F Convertible Preferred Stock | (11) | (11) | Common Stock | 223,142 | (11) | I | See footnote(3) |
Series F Convertible Preferred Stock | (11) | (11) | Common Stock | 671 | (11) | I | See footnote(4) |
Series F Convertible Preferred Stock | (11) | (11) | Common Stock | 101,733 | (11) | I | See footnote(12) |
Series F Convertible Preferred Stock | (11) | (11) | Common Stock | 6,724 | (11) | I | See footnote(5) |
Series F Convertible Preferred Stock | (11) | (11) | Common Stock | 4,483 | (11) | I | See footnote(13) |
Explanation of Responses: |
1. The Series A Convertible Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of common stock and has no expiration date. |
2. The reported securities are held of record by Rembrandt Venture Partners II, L.P. (RVP II). The Reporting Person, a the managing members of Rembrandt Venture Partners II LLC, the general partner of RVP II, shares voting and dispositive power with respect to the shares held by RVP II. The Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of any individual pecuniary interest therein. |
3. The reported securities are held of record by Rembrandt Venture Partners Fund Two, L.P. (RVPF 2). The Reporting Person, a managing member of Rembrandt Venture Partners Fund Two, LLC, the general partner of RVPF 2, shares voting and dispositive power with respect to the shares and warrants held by RVPF 2. The Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of any individual pecuniary interest therein |
4. The reported securities are held of record by Rembrandt Venture Partners Fund Two-A, L.P. (RVPF 2-A). The Reporting Person, a managing member of Rembrandt Venture Partners Fund Two, LLC, the general partner of RVPF 2-A, shares voting and dispositive power with respect to the shares and warrants held by RVPF 2-A. The Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of any individual pecuniary interest therein. |
5. The reported securities are held of record by the Casilli Family Holdings for which the the Reporting Person serves as a partner. The Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of any individual pecuniary interest therein. |
6. The reported securities are held of record by Casilli Investment Partners for which the the Reporting Person serves as a partner. The Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of any individual pecuniary interest therein |
7. The Series B Convertible Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of common stock and has no expiration date. |
8. The Series C Convertible Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of common stock and has no expiration date. |
9. The Series D Convertible Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of common stock and has no expiration date. |
10. The Series D-1 Convertible Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of common stock and has no expiration date. |
11. The Series F Convertible Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of common stock and has no expiration date. |
12. The reported securities are held of record by Rembrandt Venture Partners Opportunities Fund I, L.P. (RVP Opportunities). Messrs. Casilli, Schrier and Irwin, as the managing members of Rembrandt Venture Partners Opportunities GP I, LLC, the general partner of RVP Opportunities, share voting and dispositive power with respect to the shares and warrants held by RVP Opportunities. Messrs. Casilli, Schrier and Irwin disclaim beneficial ownership of the securities reported herein, except to the extent of any individual pecuniary interest therein. |
13. The reported securities are held of record by the Casilli Revocable Trust for which the the Reporting Person serves as a trustee. The Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of any individual pecuniary interest therein. |
Remarks: |
This report is the first of two reports, each on a separate Form 3, but relating to the same transaction being filed by Gerald S. Casilli. Exhibit 24- Power of Attorney |
/s/ Gerald S. Casilli | 06/25/2015 | |
** 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. |