| 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) 03/27/2012 |
3. Issuer Name and Ticker or Trading Symbol
Annie's, Inc. [ BNNY ] |
|||||||||||||
| 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) |
|
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 2002 Convertible Preferred Stock | (1) | (1) | Common Stock | 3,698,203 | (1) | D (2) | |
| Series A 2004 Convertible Preferred Stock | (1) | (1) | Common Stock | 5,956,484 | (1) | D (2) | |
| Series A 2005 Convertible Preferred Stock | (1) | (1) | Common Stock | 4,552,842 | (1) | D (2) | |
1. Name and Address of Reporting Person*
(Street)
|
||||||||||||
1. Name and Address of Reporting Person*
(Street)
|
||||||||||||
1. Name and Address of Reporting Person*
(Street)
|
||||||||||||
1. Name and Address of Reporting Person*
(Street)
|
||||||||||||
1. Name and Address of Reporting Person*
(Street)
|
||||||||||||
1. Name and Address of Reporting Person*
(Street)
|
| Explanation of Responses: |
| 1. The convertible preferred stock is convertible at the holder's election, at any time, or automatically upon the consummation of a firm commitment underwritten registered public offering if certain price thresholds are met. The convertible preferred stock is convertible on a one-for-1.239385 basis and has no expiration date. Concurrently with the Issuer's initial public offering, all shares of convertible preferred stock will be converted into shares of common stock of the Issuer. |
| 2. Represents shares owned by Solera Partners, L.P. and SCI Partners, L.P. Solera Partners, L.P. is controlled by its general partner, Solera Capital GP, L.P., which is controlled by its general partner, Solera GP, LLC. Molly F. Ashby is the sole managing member of Solera GP, LLC. In addition, investment and disposition decisions for Solera Partners, L.P. are generally made by a majority vote of the investment committee of Solera Capital GP, L.P., which majority vote must include Ms. Ashby. The investment committee is comprised of three members, including Ms. Ashby. SCI Partners, L.P. is controlled by its general partner, Solera GP II, LLC. Ms. Ashby is the sole managing member of Solera GP II, LLC. Ms. Ashby expressly disclaims beneficial ownership of such shares as to which she does not have a pecuniary interest. |
| Remarks: |
| This report is filed jointly by Solera Partners, L.P., SCI Partners, L.P., Solera Capital GP, L.P., Solera GP, LLC and Solera GP II, LLC, all of whom are 10% owners, and Molly F. Ashby, who is a director and a 10% owner. Exhibit List: Exhibit 24 - Power of Attorney |
| /s/ Shauna Bracher, as Attorney-in-Fact for Molly Ashby | 03/30/2012 | |
| /s/ Shauna Bracher, as Attorney-in-Fact for Solera Partners, L.P. | 03/30/2012 | |
| /s/ Shauna Bracher, as Attorney-in-Fact for SCI Partners, L.P. | 03/30/2012 | |
| /s/ Shauna Bracher, as Attorney-in-Fact for Solera Capital GP, L.P. | 03/30/2012 | |
| /s/ Shauna Bracher, as Attorney-in-Fact for Solera GP, LLC | 03/30/2012 | |
| /s/ Shauna Bracher, as Attorney-in-Fact for Solera GP II, LLC | 03/30/2012 | |
| ** 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. | ||