SEC Form 3
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*
SINGH RAJEEV

(Last) (First) (Middle)
C/O ACCOLADE, INC.
1201 THIRD AVENUE, SUITE 1700

(Street)
SEATTLE WA 98101

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/01/2020
3. Issuer Name and Ticker or Trading Symbol
Accolade, Inc. [ ACCD ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
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)
Common Stock 45,900 D
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
Stock Option (Right to Buy) (1) 10/30/2025 Common Stock 1,600,000 4.2 D
Stock Option (Right to Buy) (2) 07/26/2027 Common Stock 30,000 4.5 D
Stock Option (Right to Buy) (3) 05/02/2028 Common Stock 30,000 4.7 D
Stock Option (Right to Buy) (4) 06/24/2029 Common Stock 532,000 9.6 D
Stock Option (Right to Buy) (5) 06/16/2030 Common Stock 17,846 17.5 D
Stock Option (Right to Buy) (6) 06/16/2030 Common Stock 150,000 17.5 D
Series E Preferred Stock (7) (7) Common Stock (7) (7) I By Avanti Holdings, LLC(8)
Warrant (Right to Buy) (9) 07/26/2026(10) Common Stock 6,649 0.0005 I By Avanti Holdings, LLC(8)
Warrant (Right to Buy) (9) 03/16/2028(10) Common Stock 20,320 0.0005 I By Avanti Holdings, LLC(8)
Warrant (Right to Buy) (9) 07/31/2028(10) Common Stock 4,383 0.0005 I By Avanti Holdings, LLC(8)
Explanation of Responses:
1. The shares subject to this option shall vest at a rate of twenty-five percent of the total number of shares on the one-year anniversary of October 30, 2015 (the "October 2015 Vesting Commencement Date") and 1/48th of the total number of shares each monthly anniversary of the October 2015 Vesting Commencement Date thereafter for so long as the Reporting Person remains an employee or consultant of the Issuer, such that the total number of shares shall be fully vested on the four-year anniversary of the October 2015 Vesting Commencement Date.
2. The shares subject to this option shall vest at a rate of twenty-five percent of the total number of shares on the one-year anniversary of July 26, 2017 (the "July 2017 Vesting Commencement Date") and 1/48th of the total number of shares each monthly anniversary of the July 2017 Vesting Commencement Date thereafter for so long as the Reporting Person remains an employee or consultant of the Issuer, such that the total number of shares shall be fully vested on the four-year anniversary of the July 2017 Vesting Commencement Date.
3. The shares subject to this option shall vest at a rate of twenty-five percent of the total number of shares on the one-year anniversary of April 1, 2018 (the "April 2018 Vesting Commencement Date") and 1/48th of the total number of shares each monthly anniversary of the April 2018 Vesting Commencement Date thereafter for so long as the Reporting Person remains an employee or consultant of the Issuer, such that the total number of shares shall be fully vested on the four-year anniversary of the April 2018 Vesting Commencement Date.
4. The shares subject to this option shall vest at a rate of twenty-five percent of the total number of shares on the one-year anniversary of June 25, 2019 (the "June 2019 Vesting Commencement Date") and 1/48th of the total number of shares each monthly anniversary of the June 2019 Vesting Commencement Date thereafter for so long as the Reporting Person remains an employee or consultant of the Issuer, such that the total number of shares shall be fully vested on the four-year anniversary of the June 2019 Vesting Commencement Date.
5. The shares subject to this option are fully vested.
6. The shares subject to this option shall vest at a rate of twenty-five percent of the total number of shares on the one-year anniversary of June 1, 2020 (the "2020 Vesting Commencement Date") and 1/48th of the total number of shares each monthly anniversary of the 2020 Vesting Commencement Date thereafter for so long as the Reporting Person remains an employee or consultant of the Issuer, such that the total number of shares shall be fully vested on the four-year anniversary of the 2020 Vesting Commencement Date.
7. Avanti Holdings, LLC currently owns 297,544 shares of the Issuer's Series E Preferred Stock. Each share of the Issuer's Series E Preferred Stock has no expiration date and will automatically convert, on a certificate by certificate basis, upon the closing of the Issuer's initial public offering (the "IPO") into the number shares of the Issuer's Common Stock equal to (i) 297,544 plus (ii) a number equal to 297,544 multiplied by a fraction of $23.86195 divided by the Issuer's initial public offering price per share of the Issuer's Common Stock offered to the public in the IPO. No fractional shares shall be issued as a result of this conversion.
8. The Reporting Person is a partner of Avanti Holdings, LLC and has voting and investment power with respect to the shares held by Avanti Holdings, LLC.
9. The shares subject to this warrant are fully vested.
10. This warrant will automatically be net exercised upon the closing of the IPO if it is not exercised on or before such date.
Remarks:
Exhibit 24 - Power of Attorney
/s/ Alan Hambelton, Attorney-in-Fact 07/01/2020
** 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.
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