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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Blumberg Capital II, L. P. 432 BRYANT STREET SAN FRANCISCO, CA 94107 |
X | |||
Blumberg Capital Management II, L.L.C. 432 BRYANT STREET SAN FRANCISCO, CA 94107 |
X | |||
Blumberg David James 432 BRYANT STREET SAN FRANCISCO, CA 94107 |
X |
Blumberg Capital II, L.P., By: Blumberg Capital Management II, L.L.C., its general partner, By /s/ David J. Blumberg, Managing Member | 01/31/2022 | |
**Signature of Reporting Person | Date | |
Blumberg Capital Management II, L.L.C., By /s/ David J. Blumberg, Managing Member | 01/31/2022 | |
**Signature of Reporting Person | Date | |
/s/ David J. Blumberg | 01/31/2022 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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). |
(1) | Represents a pro rata, in-kind distribution, and not a purchase or sale of securities, by Blumberg Capital II, L.P. ("BC II") to its general partner and limited partners without additional consideration. |
(2) | Shares are held by BC II. Blumberg Capital Management II, L.L.C. ("BCM II") is the sole general partner of BC II. David J. Blumberg is the managing member of BCM II. BCM II and Mr. Blumberg have voting and investment power over the shares held by BC II. Each of BCM II and Mr. Blumberg disclaims beneficial ownership of these shares except to the extent of its or his respective pecuniary interest therein. |
(3) | Shares are held by BCM II. Mr. Blumberg is the managing member of BCM II and has voting and investment power over the shares held by BCM II. Mr. Blumberg disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
(4) | Represents a pro rata, in-kind distribution, and not a purchase or sale of securities, by BCM II to its members without additional consideration. |
(5) | Shares are held by David J. Blumberg |