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) 10/05/2016 |
3. Issuer Name and Ticker or Trading Symbol
Coupa Software Inc [ COUP ] |
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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) |
Common Stock | 85,308 | I | By Bluerun Ventures, L.P.(1) |
Common Stock | 61,250 | I | By BRV Opportunities Fund, L.P.(2) |
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 | (3) | (3) | Common Stock | 536,315 | $0.00 | I | By Bluerun Ventures, L.P.(1) |
Series B Convertible Preferred Stock | (4) | (4) | Common Stock | 279,850 | $0.00 | I | By Bluerun Ventures, L.P.(1) |
Series C Convertible Preferred Stock | (5) | (5) | Common Stock | 1,501,693 | $0.00 | I | By Bluerun Ventures, L.P.(1) |
Series D Convertible Preferred Stock | (5) | (5) | Common Stock | 1,035,787 | $0.00 | I | By Bluerun Ventures, L.P.(1) |
Series E Convertible Preferred Stock | (5) | (5) | Common Stock | 683,109 | $0.00 | I | By Bluerun Ventures, L.P.(1) |
Series F Convertible Preferred Stock | (5) | (5) | Common Stock | 618,047 | $0.00 | I | By Bluerun Ventures, L.P.(1) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. These shares are owned directly by BlueRun Ventures, L.P. ("BRV"). BRV Partners, L.L.C ("BRV GP") is the general partner of BRV and may be deemed to have sole voting and dispositive power over the shares. John Malloy and Jonathan Ebinger are the managing members of BRV GP and may be deemed to share voting and dispositive power over the shares. Each reporting person disclaims the existence of a "group." Each of BRV GP, John Malloy and Jonathan Ebinger disclaims beneficial ownership of the shares except to the extent of any pecuniary interest therein, and the filing of this report is not an admission that BRV GP, John Malloy or Jonathan Ebinger is the beneficial owner of the shares for purposes of Section 16 or any other purpose. |
2. These shares are owned directly by BRV Opportunities Fund, L.P. ("BRVOF"). BRV Opportunities Fund GP, LLC ("BRVOF GP") is the general partner of BRVOF and may be deemed to have sole voting and dispositive power over the shares. John Malloy and Jonathan Ebinger are the managing members of BRVOF GP and may be deemed to share voting and dispositive power over the shares. Each reporting person disclaims the existence of a "group." Each of BRVOF GP, John Malloy and Jonathan Ebinger disclaims beneficial ownership of the shares except to the extent of any pecuniary interest therein, and the filing of this report is not an admission that BRVOF GP, John Malloy or Jonathan Ebinger is the beneficial owner of the shares for purposes of Section 16 or any other purpose. |
3. The Series A Convertible Preferred Stock shall automatically convert into Common Stock on a 1-for-1.25561723 basis immediately prior to the completion of the Issuer's initial public offering and has no expiration date. |
4. The Series B Convertible Preferred Stock shall automatically convert into Common Stock on a 1-for-1.90043965 basis immediately prior to the completion of the Issuer's initial public offering and has no expiration date. |
5. The Series C Convertible Preferred Stock, the Series D Convertible Preferred Stock, the Series E Convertible Preferred Stock and the Series F Convertible Preferred Stock shall automatically convert into Common Stock on a 1-for-1 basis immediately prior to the completion of the Issuer's initial public offering and has no expiration date. |
Remarks: |
BRV PARTNERS, L.L.C., By: /s/ Jennifer Yu, attorney-in-fact | 10/05/2016 | |
BLUERUN VENTURES, L.P., By: BRV Partners, L.L.C., Its: General Partner, By: /s/ Jennifer Yu, attorney-in-fact | 10/05/2016 | |
BRV OPPORTUNITIES FUND GP, LLC, By: /s/ Jennifer Yu, attorney-in-fact | 10/05/2016 | |
BRV OPPORTUNITIES FUND, L.P., By: BRV Opportunities Fund GP, LLC, By: /s/ Jennifer Yu, attorney-in-fact | 10/05/2016 | |
JONATHAN EBINGER, /s/ Jennifer Yu, attorney-in-fact | 10/05/2016 | |
** 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 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. |