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)
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2. Date of Event Requiring Statement
(Month/Day/Year) 08/01/2013 |
3. Issuer Name and Ticker or Trading Symbol
CONTROL4 CORP [ CTRL ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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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 H Preferred Stock | (1) | (2) | Common Stock | 1,510,981(1) | (1) | D | |
Common Stock Warrant (right to buy) | 01/21/2011 | (3) | Common Stock | 402,928 | $9.9273 | D | |
Common Stock Warrant (right to buy) | 02/15/2011 | (4) | Common Stock | 67,154 | $9.9273 | D |
Explanation of Responses: |
1. Each share of Series H Preferred Stock is currently convertible into one share of Issuer's Common Stock for no additional consideration. In addition, each share of Series H Preferred Stock will automatically convert into one share of Issuer's Common Stock upon the closing of the Issuer's initial public offering for no additional consideration. |
2. None. |
3. This warrant expires upon the earlier of (i) an initial public offering of the Issuer's securities or (ii) January 21, 2014. |
4. This warrant expires upon the earlier of (i) an initial public offering of the Issuer's securities or (ii) February 15, 2014. |
Remarks: |
Following the closing of the Issuer's initial public offering, the Reporting Person expects that the securities reported herein will represent beneficial ownership of the Issuer of less than 10%, as indicated in the Issuer's registration statement on Form S-1 (No. 333-189736). |
Cisco Systems, Inc. By: /s/ Evan Sloves, Assistant Secretary | 08/01/2013 | |
** 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. |