X0306 4 2015-12-31 0 0001090908 DETERMINE, INC. DTRM 0000949119 MILLER LLOYD I III 3300 SOUTH DIXIE HIGHWAY SUITE 1-365 WEST PALM BEACH FL 33405 0 0 1 0 Common Stock 2015-12-31 4 J 0 659 3.75 A 13961 D Common Stock 2015-12-31 4 J 0 659 3.75 A 1116458 I By Milfam II L.P. Common Stock 2015-12-31 4 J 0 659 3.75 A 644731 I By Trust A-4 - Lloyd I. Miller Common Stock 159574 I By Milgrat (K10) Common Stock 87410 I By Milgrat (D10) Common Stock 87606 I By Trust C - Lloyd I. Miller Common Stock 2100 I By Trust D - Lloyd I. Miller Common Stock 159574 I By Milfam I L.P. Junior Secured Convertible Promissory Note 3.75 2015-12-16 2020-12-16 Common Stock 160000 160000 D Junior Secured Convertible Promissory Note 3.75 2015-12-16 2020-12-16 Common Stock 160000 160000 I By Milfam II L.P. Junior Secured Convertible Promissory Note 3.75 2015-12-16 2020-12-16 Common Stock 160000 160000 I By Trust A-4 - Lloyd I. Miller Warrant 6.00 Common Stock 79787 79787 I By Milfam I L.P. Warrant 6.00 Common Stock 79787 79787 I By Milfam II L.P. Warrant 6.00 Common Stock 79787 79787 I By Milgrat (K10) Junior Secured Convertible Promissory Notes 5.70 2020-12-16 Common Stock 175438.59 175438.59 I By Milfam II L.P. Junior Secured Convertible Promissory Notes 5.70 2020-12-16 Common Stock 175438.59 175438.59 I By Trust A-4 - Lloyd I. Miller Junior Secured Convertible Promissory Notes 5.70 2020-12-16 Common Stock 175438.59 175438.59 D Warrant 7.00 2014-08-27 2019-08-27 Common Stock 49401 49401 I By Trust A-4 - Lloyd I. Miller Warrant 7.00 2014-08-27 2019-08-27 Common Stock 13722 13722 I By Milgrat (D10) Warrant 7.00 2014-08-27 2019-08-27 Common Stock 74102 74102 I By Milfam II L.P. Warrant 7.00 2014-07-24 2019-07-24 Common Stock 57558 57558 I By Trust A-4 - Lloyd I. Miller Warrant 7.00 2014-07-24 2019-07-24 Common Stock 15988 15988 I By Milgrat (D10) Warrant 7.00 2014-07-24 2019-07-24 Common Stock 86338 86338 I By Milfam II L.P. Series A Warrant 7.75 2013-12-01 2018-05-31 Common Stock 40894 40894 I By Trust A-4 - Lloyd I. Miller Series A Warrant 7.75 2013-12-01 2018-05-31 Common Stock 11359 11359 I By Milgrat (D10) Series A Warrant 7.75 2013-12-01 2018-05-31 Common Stock 61342 61342 I By Milfam II L.P. Accrued interest on the junior secured convertible promissory note paid in the form of common stock by converting such accrued interest amount to common stock at the conversion price of $3.75. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. This filing shall not be deemed an admission that the reporting person is, for purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, the beneficial owner of any equity securities covered by this filing. Such Warrant will be exercisable six months following the date of issuance, February 6, 2015. Such Warrant will expire on the fifth anniversary of the exercisability date. As previously reported, the issuer entered into a binding term sheet with the reporting person pursuant to which the issuer agreed to issue and the reporting person agreed to purchase, junior secured convertible promissory notes in the aggregate principal amount of $3 million subject to negotiation and execution of definitive documentation. On March 11, 2015, the notes were executed and on May 5, 2015, the shareholders approved the conversion of the notes at the stockholders meeting. The issuer and the reporting person agreed to amend the maturity date from March 11, 2020 to December 16, 2020. Subject to adjustment for fractional shares. /s/ David J. Hoyt Attorney-in-fact 2016-01-05