0001209191-21-028131.txt : 20210423 0001209191-21-028131.hdr.sgml : 20210423 20210423163535 ACCESSION NUMBER: 0001209191-21-028131 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210423 FILED AS OF DATE: 20210423 DATE AS OF CHANGE: 20210423 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MENDOZA THOMAS F CENTRAL INDEX KEY: 0001227747 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40348 FILM NUMBER: 21850354 MAIL ADDRESS: STREET 1: 495 E. JAVA DRIVE CITY: SUNNYVALE STATE: CA ZIP: 94089 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: UiPath, Inc. CENTRAL INDEX KEY: 0001734722 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 474333187 STATE OF INCORPORATION: DE FISCAL YEAR END: 0131 BUSINESS ADDRESS: STREET 1: 90 PARK AVE STREET 2: 20TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10016 BUSINESS PHONE: (844) 432-0455 MAIL ADDRESS: STREET 1: 90 PARK AVE STREET 2: 20TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10016 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-04-23 0 0001734722 UiPath, Inc. PATH 0001227747 MENDOZA THOMAS F C/O UIPATH, INC., 90 PARK AVE, 20TH FL NEW YORK NY 10016 1 0 0 0 Class A Common Stock 2021-04-23 4 C 0 57180 A 1668300 I See Footnote Class A Common Stock 2021-04-23 4 C 0 16950 A 1685250 I See Footnote Class A Common Stock 2021-04-23 4 C 0 17430 A 1702680 I See Footnote Class A Common Stock 2021-04-23 4 C 0 13920 A 1716600 I See Footnote Class A Common Stock 2021-04-23 4 C 0 13053 A 1729653 I See Footnote Class A Common Stock 2021-04-23 4 C 0 2193 A 1731846 I See Footnote Class A Common Stock 2021-04-23 4 S 0 120726 56.00 D 1611120 I See Footnote Class A Common Stock 100000 I See Footnote Series B-1 Preferred Stock 2021-04-23 4 C 0 57180 0.00 D Class A Common Stock 57180 0 I See Footnote Series B-2 Preferred Stock 2021-04-23 4 C 0 16950 0.00 D Class A Common Stock 16950 0 I See Footnote Series C-1 Preferred Stock 2021-04-23 4 C 0 17430 0.00 D Class A Common Stock 17430 0 I See Footnote Series C-2 Preferred Stock 2021-04-23 4 C 0 13920 0.00 D Class A Common Stock 13920 0 I See Footnote Series D-1 Preferred Stock 2021-04-23 4 C 0 13053 0.00 D Class A Common Stock 13053 0 I See Footnote Series D-2 Preferred Stock 2021-04-23 4 C 0 2193 0.00 D Class A Common Stock 2193 0 I See Footnote Each share of Series B-1 Preferred Stock, Series B-2 Preferred Stock, Series C-1 Preferred Stock, Series C-2 Preferred Stock, Series D-1 Preferred Stock and Series D-2 Preferred Stock and Series F Preferred Stock automatically converted into one share of Class A Common Stock, without payment of additional consideration, immediately prior to the closing of the Issuer's initial public offering. Shares are held directly by the Amended and Restated Thomas F. Mendoza Revocable Trust, of which Reporting Person is the trustee and a beneficiary. Shares are held directly by the Thomas F. Mendoza 2021 GRAT, of which the Reporting Person is the trustee and a beneficiary. /s/ Brad Brubaker, Attorney-in-Fact 2021-04-23