4: Statement of changes in beneficial ownership of securities
Published on April 23, 2021
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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) |
(e.g., puts, calls, warrants, options, convertible securities)
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 | ||||||||
Series B-1 Preferred Stock | (1) | 04/23/2021 | C | 117,450 | (1) | (1) | Class A Common Stock | 117,450 | $ 0 | 0 | I | By Accel Growth Fund IV Strategic Partners L.P. (2) | |||
Series B-2 Preferred Stock | (1) | 04/23/2021 | C | 34,830 | (1) | (1) | Class A Common Stock | 34,830 | $ 0 | 0 | I | By Accel Growth Fund IV Strategic Partners L.P. (2) | |||
Series C-1 Preferred Stock ( | (1) | 04/23/2021 | C | 4,707 | (1) | (1) | Class A Common Stock | 4,707 | $ 0 | 0 | I | By Accel Growth Fund IV Strategic Partners L.P. (2) | |||
Series C-2 Preferred Stock ( | (1) | 04/23/2021 | C | 3,759 | (1) | (1) | Class A Common Stock | 3,759 | $ 0 | 0 | I | By Accel Growth Fund IV Strategic Partners L.P. (2) | |||
Series D-1 Preferred Stock | (1) | 04/23/2021 | C | 1,056 | (1) | (1) | Class A Common Stock | 1,056 | $ 0 | 0 | I | By Accel Growth Fund IV Strategic Partners L.P. (2) | |||
Series D-2 Preferred Stock | (1) | 04/23/2021 | C | 177 | (1) | (1) | Class A Common Stock | 177 | $ 0 | 0 | I | By Accel Growth Fund IV Strategic Partners L.P. (2) | |||
Series B-1 Preferred Stock | (1) | 04/23/2021 | C | 987,330 | (1) | (1) | Class A Common Stock | 987,330 | $ 0 | 0 | I | By Accel Growth Fund Investors 2016 L.L.C. (3) | |||
Series B-2 Preferred Stock | (1) | 04/23/2021 | C | 292,860 | (1) | (1) | Class A Common Stock | 292,860 | $ 0 | 0 | I | By Accel Growth Fund Investors 2016 L.L.C. (3) | |||
Series C-1 Preferred Stock | (1) | 04/23/2021 | C | 39,564 | (1) | (1) | Class A Common Stock | 39,564 | $ 0 | 0 | I | By Accel Growth Fund Investors 2016 L.L.C. (3) | |||
Series C-2 Preferred Stock | (1) | 04/23/2021 | C | 31,602 | (1) | (1) | Class A Common Stock | 31,602 | $ 0 | 0 | I | By Accel Growth Fund Investors 2016 L.L.C. (3) | |||
Series D-1 Preferred Stock | (1) | 04/23/2021 | C | 8,889 | (1) | (1) | Class A Common Stock | 8,889 | $ 0 | 0 | I | By Accel Growth Fund Investors 2016 L.L.C. (3) | |||
Series D-2 Preferred Stock | (1) | 04/23/2021 | C | 1,494 | (1) | (1) | Class A Common Stock | 1,494 | $ 0 | 0 | I | By Accel Growth Fund Investors 2016 L.L.C. (3) | |||
Series C-1 Preferred Stock | (1) | 04/23/2021 | C | 3,326,970 | (1) | (1) | Class A Common Stock | 3,326,970 | $ 0 | 0 | I | By Accel Leaders Fund L.P. (4) | |||
Series C-2 Preferred Stock | (1) | 04/23/2021 | C | 2,657,322 | (1) | (1) | Class A Common Stock | 2,657,322 | $ 0 | 0 | I | By Accel Leaders Fund L.P. (4) | |||
Series D-1 Preferred Stock | (1) | 04/23/2021 | C | 747,579 | (1) | (1) | Class A Common Stock | 747,579 | $ 0 | 0 | I | By Accel Leaders Fund L.P. (4) | |||
Series D-2 Preferred Stock | (1) | 04/23/2021 | C | 125,532 | (1) | (1) | Class A Common Stock | 125,532 | $ 0 | 0 | I | By Accel Leaders Fund L.P. (4) | |||
Series E Preferred Stock | (1) | 04/23/2021 | C | 25,665 | (1) | (1) | Class A Common Stock | 25,665 | $ 0 | 0 | I | By Accel Leaders Fund L.P. (4) | |||
Series C-1 Preferred Stock | (1) | 04/23/2021 | C | 158,958 | (1) | (1) | Class A Common Stock | 158,958 | $ 0 | 0 | I | By Accel Leaders Fund Investors 2016 L.L.C. (5) | |||
Series C-2 Preferred Stock | (1) | 04/23/2021 | C | 126,963 | (1) | (1) | Class A Common Stock | 126,963 | $ 0 | 0 | I | By Accel Leaders Fund Investors 2016 L.L.C. (5) | |||
Series D-1 Preferred Stock | (1) | 04/23/2021 | C | 35,718 | (1) | (1) | Class A Common Stock | 35,718 | $ 0 | 0 | I | By Accel Leaders Fund Investors 2016 L.L.C. (5) | |||
Series D-2 Preferred Stock | (1) | 04/23/2021 | C | 5,997 | (1) | (1) | Class A Common Stock | 5,997 | $ 0 | 0 | I | By Accel Leaders Fund Investors 2016 L.L.C. (5) | |||
Series E Preferred Stock | (1) | 04/23/2021 | C | 1,226 | (1) | (1) | Class A Common Stock | 1,226 | $ 0 | 0 | I | By Accel Leaders Fund Investors 2016 L.L.C. (5) |
Reporting Owners
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Botteri Philippe C/O UIPATH, INC., 90 PARK AVE, 20TH FL NEW YORK, NY 10016 |
X | X |
Signatures
/s/ Brad Brubaker, as Attorney-in-Fact | 04/23/2021 | |
**Signature of Reporting Person | Date |
Explanation of Responses:
* | 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) | Each share of Series A-1 Preferred Stock, 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, Series D-2 Preferred Stock, Series E 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. |
(2) | Accel Growth Fund IV Associates L.L.C., or AGF4A, is the General Partner of both Accel Growth Fund IV L.P. and Accel Growth Fund IV Strategic Partners L.P., and has sole voting and investment power. Andrew G. Braccia, Sameer K. Gandhi, Ping Li, Tracy L. Sedlock, Ryan J. Sweeney, and Richard P. Wong are the Managing Members of AGF4A and share such powers. Such managers and the Reporting Person disclaim beneficial ownership except to the extent of their pecuniary interest therein. |
(3) | Andrew G. Braccia, Sameer K. Gandhi, Ping Li, Tracy L. Sedlock, Ryan J. Sweeney, and Richard P. Wong are the Managing Members of Accel Growth Fund Investors 2016 L.L.C. and share the voting and investment powers. Such managers and the Reporting Person disclaim beneficial ownership except to the extent of their pecuniary interest therein. |
(4) | Accel Leaders Fund Associates L.L.C., or ALFA, is the General Partner of Accel Leaders Fund L.P. and has sole voting and investment power. Andrew G. Braccia, Sameer K. Gandhi, Ping Li, Tracy L. Sedlock, Ryan J. Sweeney, and Richard P. Wong are the Managing Members of ALFA and share such powers. Such managers and the Reporting Person disclaim beneficial ownership except to the extent of their pecuniary interest therein. |
(5) | Andrew G. Braccia, Sameer K. Gandhi, Ping Li, Tracy L. Sedlock, Ryan J. Sweeney, and Richard P. Wong are the Managing Members of Accel Leaders Fund Investors 2016 L.L.C. and share voting and investment powers. Such managers and the Reporting Person disclaim beneficial ownership except to the extent of their pecuniary interest therein. |
Remarks: This Form 4 is the second of two Form 4s filed relating to the same event. Combined, the two reports report the holdings for the Reporting Person, a director of the Issuer and his indirect relationship to the following reporting persons: Accel London V L.P., Accel London V Strategic Partners L.P., Accel London Investors 2016 L.P., Accel London V Associates L.P., Accel London V Associates L.L.C., Accel Leaders Fund L.P., Accel Leaders Fund Associates L.L.C., Accel Leaders Fund Investor 2016 L.L.C., Accel Growth Fund IV, L.P., Accel Growth Fund IV Strategic Partners L.P., Accel Growth Fund IV Associates L.L.C. and Accel Growth Fund Investors 2016 L.L.C. This Form 4 has been split into two filings because there are more than 10 reporting persons in total, and the SEC's EDGAR filing system limits a single Form 4 to a maximum of 10 reporting persons and 30 reportable holdings. Each Form 4 is filed by the Reporting Person. |