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 | 10,004,580 | (1) | (1) | Class A Common Stock | 10,004,580 | $ 0 | 0 | I | By CapitalG LP (2) | |||
Series B-2 Preferred Stock | (1) | 04/23/2021 | C | 2,967,450 | (1) | (1) | Class A Common Stock | 2,967,450 | $ 0 | 0 | I | By CapitalG LP (2) | |||
Series C-1 Preferred Stock | (1) | 04/23/2021 | C | 2,178,705 | (1) | (1) | Class A Common Stock | 2,178,705 | $ 0 | 0 | I | By CapitalG LP (2) | |||
Series C-1 Preferred Stock | (1) | 04/23/2021 | C | 6,536,115 | (1) | (1) | Class A Common Stock | 6,536,115 | $ 0 | 0 | I | By CapitalG II LP (3) | |||
Series C-2 Preferred Stock | (1) | 04/23/2021 | C | 1,740,180 | (1) | (1) | Class A Common Stock | 1,740,180 | $ 0 | 0 | I | By CapitalG LP (2) | |||
Series C-2 Preferred Stock | (1) | 04/23/2021 | C | 5,220,537 | (1) | (1) | Class A Common Stock | 5,220,537 | $ 0 | 0 | I | By CapitalG II LP (3) | |||
Series D-1 Preferred Stock | (1) | 04/23/2021 | C | 1,631,871 | (1) | (1) | Class A Common Stock | 1,631,871 | $ 0 | 0 | I | By CapitalG II LP (3) | |||
Series D-2 Preferred Stock | (1) | 04/23/2021 | C | 274,020 | (1) | (1) | Class A Common Stock | 274,020 | $ 0 | 0 | I | By CapitalG II LP (3) |
Reporting Owners
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Sturdy Laela C/O UIPATH, INC., 90 PARK AVE, 20TH FL NEW YORK, NY 10016 |
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 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 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 (IPO). |
(2) | CapitalG GP LLC, is the general partner of CapitalG LP. Alphabet Holdings LLC, the managing member of CapitalG GP LLC, XXVI Holdings Inc., the managing member of Alphabet Holdings LLC, and Alphabet Inc., the controlling stockholder of XXVI Holdings Inc., each may be deemed to share voting and investment power over the shares held by CapitalG LP. The Reporting Person is a general partner of CapitalG LP and may be deemed to share voting and investment power over the shares. The Reporting Person disclaims beneficial ownership of the shares held by CapitalG LP except to the extent of her pecuniary interest in such shares. |
(3) | CapitalG II GP LLC, is the general partner of CapitalG II LP. Alphabet Holdings LLC, the managing member of CapitalG II GP LLC, XXVI Holdings Inc., the managing member of Alphabet Holdings LLC, and Alphabet Inc., the controlling stockholder of XXVI Holdings Inc., each may be deemed to share voting and investment power over the shares held by CapitalG II LP. The Reporting Person is a general partner of CapitalG II LP and may be deemed to share voting and investment power over the shares. The Reporting Person disclaims beneficial ownership of the shares held by CapitalG II LP except to the extent of her pecuniary interest in such shares. |
(4) | 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. |