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*
Thayne Daren

(Last) (First) (Middle)
772 EAST UTAH VALLEY DR.

(Street)
AMERICAN FORK UT 84003

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/15/2023
3. Issuer Name and Ticker or Trading Symbol
DOMO, INC. [ DOMO ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
CTO & EVP Engineering
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)
Class B Common Stock 203,301(1) D
Class B Common Stock 103,552 I DAREN AND SHARISA THAYNE FAMILY, LLC
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
Explanation of Responses:
1. Includes 117,188 shares underlying outstanding grants of restricted stock units ("RSUs") as follows: (i) 1,250 RSUs, vesting in equal quarterly installments; (ii) 23,438 RSUs, vesting in equal quarterly installments; (iii) 50,000 RSUs, vesting in equal quarterly installments; (iv) 22,500 RSUs, vesting in equal quarterly installments; and (v) 20,000 RSUs, one-fourth of which will vest on March 20, 2023, with one-sixteenth of the total number of RSUs vesting in equal quarterly installments thereafter. Each RSU represents a contingent right to receive one share of our Class B common stock, subject to continued service through the applicable vesting date(s).
Remarks:
Exhibit 24: Power of Attorney
Daniel Stevenson, attorney-in-fact 01/17/2023
** 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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.