FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Coupa Software Inc [ COUP ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 10/06/2016 | ||||||||||||||||||||||||||
4. 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 Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 10/06/2016 | P | 1,000(1) | A | $35 | 1,000 | I | By: Michael Scott Irwin, Trustee of RVP DBP II(1) | ||
Common Stock | 10/06/2016 | P | 500 | A | $36 | 500 | D | |||
Common Stock | 10/12/2016 | C | 5,057,977 | A | (2) | 5,185,993 | I | By El Dorado Ventures VII L.P.(3) | ||
Common Stock | 10/12/2016 | C | 157,902 | A | (2) | 161,898 | I | By El Dorado Technology '05 L.P.(3) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series C Convertible Preferred Stock | $1.278 | 10/12/2016 | (2) | C | 2,845,440 | (2) | (2) | Common Stock | 2,845,440 | (2) | 0 | I | By El Dorado Ventures VII L.P.(3) | ||
Series D Convertible Preferred Stock | $1.3524 | 10/12/2016 | (2) | C | 1,093,858 | (2) | (2) | Common Stock | 1,093,858 | (2) | 0 | I | By El Dorado Ventures VII L.P.(3) | ||
Series E Convertible Preferred Stock | $3.1148 | 10/12/2016 | (2) | C | 721,407 | (2) | (2) | Common Stock | 721,407 | (2) | 0 | I | By El Dorado Ventures VII L.P.(3) | ||
Series F Convertible Preferred Preferred Stock | $8.09 | 10/12/2016 | (2) | C | 299,668 | (2) | (2) | Common Stock | 299,668 | (2) | 0 | I | By El Dorado Ventures VII L.P.(3) | ||
Series G Convertible Preferred Stock | $16.7232 | 10/12/2016 | (2) | C | 97,604 | (2) | (2) | Common Stock | 97,604 | (2) | 0 | I | By El Dorado Ventures VII L.P.(3) | ||
Series C Convertible Preferred Stock | $1.278 | 10/12/2016 | (2) | C | 88,831 | (2) | (2) | Common Stock | 88,831 | (2) | 0 | I | By El Dorado Technology '05 L.P.(3) | ||
Series D Convertible Preferred Stock | $1.3524 | 10/12/2016 | (2) | C | 34,149 | (2) | (2) | Common Stock | 34,149 | (2) | 0 | I | By El Dorado Technology '05 L.P.(3) | ||
Series E Convertible Preferred Stock | $3.1148 | 10/12/2016 | (2) | C | 22,521 | (2) | (2) | Common Stock | 22,521 | (2) | 0 | I | By El Dorado Technology '05 L.P.(3) | ||
Series F Convertible Preferred Stock | $8.09 | 10/12/2016 | (2) | C | 9,355 | (2) | (2) | Common Stock | 9,355 | (2) | 0 | I | By El Dorado Technology '05 L.P.(3) | ||
Series G Convertible Preferred Stock | $16.7232 | 10/12/2016 | (2) | C | 3,046 | (2) | (2) | Common Stock | 3,046 | (2) | 0 | I | By El Dorado Technology '05 L.P.(3) |
Explanation of Responses: |
1. The shares are held by Michael Scott Irwin, Trustee of RVP DEP II of which the Reporting Person is a trustee and beneficiary. |
2. Each share of Series C Convertible Preferred Stock, Series D Convertible Preferred Stock, Series E Convertible Preferred Stock, Series F Convertible Preferred Stock and Series G Convertible Preferred Stock automatically converted into one share of Issuer's Common Stock for no additional consideration immediately prior to the completion of the Issuer's initial public offering. The exercisability date and expiration date are not relevant to the conversion of these securities. |
3. The Reporting Person is a managing member at El Dorado Venture Partners VII, LLC ("EDVP"), the general partner of El Dorado Technology '05 L.P. ("EDT") and El Dorado Ventures VII L.P. ("EDV"). The Reporting Person is a managing member of EDVP and shares voting and investment power over the shares owned by EDT and EDV. The Reporting Person disclaims beneficial ownership in the shares held by the aforementioned entities except to the extent of his pecuniary interest therein. |
Remarks: |
/s/ M. Scott Irwin | 10/14/2016 | |
** 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 4 (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. |