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 A-1 Preferred Stock | (1) | 04/23/2021 | C | 58,774,710 | (1) | (1) | Class A Common Stock | 58,774,710 | $ 0 | 0 | I | By Accel London V L.P. (2) | |||
Series B-1 Preferred Stock | (1) | 04/23/2021 | C | 2,570,880 | (1) | (1) | Class A Common Stock | 2,570,880 | $ 0 | 0 | I | By Accel London V L.P. (2) | |||
Series B-2 Preferred Stock | (1) | 04/23/2021 | C | 762,570 | (1) | (1) | Class A Common Stock | 762,570 | $ 0 | 0 | I | By Accel London V L.P. (2) | |||
Series E Preferred Stock | (1) | 04/23/2021 | C | 24,186 | (1) | (1) | Class A Common Stock | 24,186 | $ 0 | 0 | I | By Accel London V L.P. (2) | |||
Series A-1 Preferred Stock | (1) | 04/23/2021 | C | 895,290 | (1) | (1) | Class A Common Stock | 895,290 | $ 0 | 0 | I | By Accel London V Strategic Partners L.P. (2) | |||
Series B-1 Preferred Stock | (1) | 04/23/2021 | C | 39,150 | (1) | (1) | Class A Common Stock | 39,150 | $ 0 | 0 | I | By Accel London V Strategic Partners L.P. (2) | |||
Series B-2 Preferred Stock | (1) | 04/23/2021 | C | 11,610 | (1) | (1) | Class A Common Stock | 11,610 | $ 0 | 0 | I | By Accel London V Strategic Partners L.P. (2) | |||
Series E Preferred Stock | (1) | 04/23/2021 | C | 368 | (1) | (1) | Class A Common Stock | 368 | $ 0 | 0 | I | By Accel London V Strategic Partners L.P. (2) | |||
Series A-1 Preferred Stock | (1) | 04/23/2021 | C | 5,678,790 | (1) | (1) | Class A Common Stock | 5,678,790 | $ 0 | 0 | I | By Accel London Investors 2016 L.P. (3) | |||
Series B-1 Preferred Stock | (1) | 04/23/2021 | C | 248,400 | (1) | (1) | Class A Common Stock | 248,400 | $ 0 | 0 | I | By Accel London Investors 2016 L.P. (3) | |||
Series B-2 Preferred Stock ( | (1) | 04/23/2021 | C | 73,680 | (1) | (1) | Class A Common Stock | 73,680 | $ 0 | 0 | I | By Accel London Investors 2016 L.P. (3) | |||
Series E Preferred Stock | (1) | 04/23/2021 | C | 2,337 | (1) | (1) | Class A Common Stock | 2,337 | $ 0 | 0 | I | By Accel London Investors 2016 L.P. (3) | |||
Series B-1 Preferred Stock | (1) | 04/23/2021 | C | 20,642,310 | (1) | (1) | Class A Common Stock | 20,642,310 | $ 0 | 0 | I | By Accel Growth Fund IV L.P. (4) | |||
Series B-2 Preferred Stock | (1) | 04/23/2021 | C | 6,122,730 | (1) | (1) | Class Class A Common Stock | 6,122,730 | $ 0 | 0 | I | By Accel Growth Fund IV L.P. (4) | |||
Series C-1 Preferred Stock | (1) | 04/23/2021 | C | 827,211 | (1) | (1) | Class A Common Stock | 827,211 | $ 0 | 0 | I | By Accel Growth Fund IV L.P. (4) | |||
Series C-2 Preferred Stock | (1) | 04/23/2021 | C | 660,711 | (1) | (1) | Class A Common Stock | 660,711 | $ 0 | 0 | I | By Accel Growth Fund IV L.P. (4) | |||
Series D-1 Preferred Stock | (1) | 04/23/2021 | C | 185,880 | (1) | (1) | Class A Common Stock | 185,880 | $ 0 | 0 | I | By Accel Growth Fund IV L.P. (4) | |||
Series D-2 Preferred Stock | (1) | 04/23/2021 | C | 31,212 | (1) | (1) | Class A Common Stock | 31,212 | $ 0 | 0 | I | By Accel Growth Fund IV L.P. (4) |
Reporting Owners
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Wong Rich C/O UIPATH, INC., 90 PARK AVE, 20TH FL NEW YORK, NY 10016 |
X | X |
Signatures
/s/ Brad Brubaker, 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) | These shares are held by Accel London V L.P. Accel London V Associates L.L.C., or ALA L.L.C., is the General Partner of Accel London V Associates L.P., which is the general partner of each of Accel London V L.P., and Accel London V Strategic Partners L.P. ALA L.L.C. has sole voting and investment power. Philippe Botteri, Hendrik Nelis, and Sonali de Rycker are the managers of ALA L.L.C. and share such powers. Such managers and the Reporting Person disclaim beneficial ownership except to the extent of their pecuniary interest therein. |
(3) | ALA L.L.C. is the General Partner of Accel London Investors 2016 L.P. and has sole voting and investment power. Philippe Botteri, Hendrik Nelis, and Sonali de Rycker are the managers of ALA L.L.C. and share such powers. Such managers and the Reporting Person disclaim beneficial ownership except to the extent of their pecuniary interest therein. |
(4) | 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. |
(5) | Consists of 16,057 Restricted Stock Units (RSUs). Each RSU represents a contingent right to receive one share of the Issuer's Class A Common Stock upon settlement. Following the closing of the IPO, 1/16th of the RSUs vest for each quarter of continuous service by the Reporting Person to the Issuer following March 16, 2021 and subject to continuous service through each such vesting date. |
Remarks: This Form 4 is the first 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. |