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*
Toth David

(Last) (First) (Middle)
1250 53RD STREET, SUITE 1

(Street)
EMERYVILLE CA 94608

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/17/2014
3. Issuer Name and Ticker or Trading Symbol
TUBEMOGUL INC [ TUBE ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
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 100,000 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
Series A Preferred Stock (Convertible) (1) (1) Common Stock 28,465 (1) D
Employee Stock Option (right to buy) (2) 04/19/2022 Common Stock 50,000 $0.7 D
Explanation of Responses:
1. The Series A Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the closing of the Issuer's initial public offering and has no expiration date.
2. Subject to the Reporting Person's continued service to the Issuer, shares subject to the option vest monthly over four years beginning on 4/19/2012.
Remarks:
The Reporting Person holds restricted stock units ("RSUs") that are not yet reportable for purposes of Section 16 and are not included in this Form 3. The shares of the Issuer's common stock underlying the RSUs will vest upon the satisfaction of both a service condition and an event condition. The event condition will be satisfied on the first to occur, if any, of (i) the date that is the earlier of (A) six (6) months after the effective date of the closing of the initial underwritten public offering of the Issuer's common stock pursuant to an effective registration statement, or (B) March 15, 2015; and (ii) the time immediately prior to the consummation of a change in control.
Eric Deeds, as Power of Attorney on behalf of David Toth 07/17/2014
** 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.