0001104659-21-024606.txt : 20210216 0001104659-21-024606.hdr.sgml : 20210216 20210216215215 ACCESSION NUMBER: 0001104659-21-024606 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201231 FILED AS OF DATE: 20210216 DATE AS OF CHANGE: 20210216 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BORDES PETER A JR CENTRAL INDEX KEY: 0001191973 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39441 FILM NUMBER: 21642426 MAIL ADDRESS: STREET 1: C/O BEASLEY BROADCAST GROUP, INC. STREET 2: 3033 RIVIERA DRIVE, SUITE 200 CITY: NAPLES STATE: FL ZIP: 34103 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Kubient, Inc. CENTRAL INDEX KEY: 0001729750 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER INTEGRATED SYSTEMS DESIGN [7373] IRS NUMBER: 821808844 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 228 PARK AVENUE STREET 2: SOUTH SUITE 72602 CITY: NEW YORK STATE: NY ZIP: 10003 BUSINESS PHONE: (800) 409-9456 MAIL ADDRESS: STREET 1: 228 PARK AVENUE STREET 2: SOUTH SUITE 72602 CITY: NEW YORK STATE: NY ZIP: 10003 5 1 tm216792d6_5.xml OWNERSHIP DOCUMENT X0306 5 2020-12-31 0 0 0 0001729750 Kubient, Inc. KBNT 0001191973 BORDES PETER A JR C/O KUBIENT, INC. 228 PARK AVENUE SOUTH, SUITE 72602 NEW YORK NY 10003 0 0 0 1 Former Chief Executive Officer Common Stock 2020-08-14 5 C 0 218780 A 238522 D Common Stock 2020-11-20 5 A 0 15000 0 A 253522 D Common Stock Purchase Warrant 5.50 2020-08-14 5 C 0 218780 A 2020-08-14 2025-08-14 Common Stock 218780 218780 D Represents the shares of common stock of Kubient, Inc. (the "Company") issued upon conversion of $859,434 of promissory notes that, upon the initial public offering of the Company, converted into 218,780 immediately-separable units composed of (i) one share of common stock, and (ii) one warrant to purchase one share of common stock at a price of $5.50 per share. Includes 62,470 such units held by Trajectory Capital LLC, over which the reporting person has voting and dispositive power. Not previously reported on Form 4. Includes 62,470 shares of common stock held by Trajectory Capital LLC, over which the reporting person has voting and dispositive power. Does not include 218,780 shares of common stock underlying five-year warrants issued on August 14, 2020, which are reported on Table II of this Form 5. Additionally, does not include 147,429 immediately-separable units composed of (i) one share of common stock, and (ii) one warrant to purchase one share of common stock at a price of $5.50 per share, underlying five-year warrants issued on November 6, 2019. Represents the warrants to purchase shares of common stock issued upon conversion of $859,434 of promissory notes that, upon the initial public offering of the Company, converted into 218,780 immediately-separable units composed of (i) one share of common stock, and (ii) one warrant to purchase one share of common stock at a price of $5.50 per share. Includes 62,470 warrants to purchase one share of common stock held by Trajectory Capital LLC, over which the reporting person has voting and dispositive power. /s/ Peter A. Bordes, Jr. 2021-02-15