UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Option (Right to Buy) | (2) | 04/14/2026 | Common Stock | 21,000 | $ 1.5 | D | |
Series A Convertible Preferred Stock | 07/16/2014 | (3) | Common Stock | 20,490 (3) | $ 2.9412 (3) | I | By RimLight, LLC (1) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Oates Christopher J. C/O VERITONE, INC. 3366 VIA LIDO NEWPORT BEACH, CA 92663 |
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/s/ Ellen S. Bancroft, Attorney-in-Fact | 05/11/2017 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Mr. Oates is a managing director of RimLight, LLC, however, this filing shall not be deemed an admission that such person is, for purposes of Section 16 of the Act or otherwise, the beneficial owner of such securities. |
(2) | 25% of the option shares vested on August 7, 2015 (the first anniversary after the vesting commencement date), and the remaining option shares vest in 36 equal monthly installments thereafter. |
(3) | The reporting person beneficially owns 27,429 shares of Series A convertible preferred stock, which is convertible into common stock at any time at the election of the holder or automatically converts into common stock upon completion the proposed initial public offering at a rate of approximately .74 (which includes accrued liquidation preferences as of May 17, 2017). The Series A convertible preferred stock has no expiration date. The conversion price reported in Column 4 reflects a 1-for-.60 reverse stock split of the common stock effected in April 2017. |