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