Accession Number: | 0001209191-21-048265 |
Date: | 2021-07-26 |
Issuer: | COUCHBASE, INC. (BASE) |
Original Submission Date: |
SORENSON CAPITAL PARTNERS III, LP
3400 ASHTON BOULEVARD, #400
LEHI, UT 84043
SORENSON CAPITAL PARTNERS III-A, LP
3400 ASHTON BOULEVARD, #400
LEHI, UT 84043
SORENSON CAPITAL PARTNERS III-B, LP
3400 ASHTON BOULEVARD, #400
LEHI, UT 84043
Title of Security | Transaction Date | 2a. Deemed Execution Date | Transaction Code | Shares | Acquired or Disposed | Price per share | 5. Amount of Securities Beneficially Owned Following Reported Transaction | 6. Ownership Form Direct or Indirect | Nature of Indirect Ownership |
---|---|---|---|---|---|---|---|---|---|
COMMON STOCK | 2021-07-26 | C | 3,248,392 | a | $0.00 | 3,406,128 | indirect |
Title of Derivative Security | Conversion or Exercise Price of Derivative Security | Transaction Date | Deemed Execution Date | Transaction Code | Number of Derivative Securities Acquired (A) or Disposed of (D) | Date Exercisable | Expiration Date | Title and Amount of Securities Underlying Derivative Security | Price of Derivative Security | Number of derivative Securities Beneficially Owned Following Reported Transaction(s) | Ownership Form: Direct (D) or Indirect (I) | Nature of Indirect Beneficial Ownership |
---|---|---|---|---|---|---|---|---|---|---|---|---|
SERIES F PREFERRED STOCK | 0.0 | 2021-07-26 | deemed execution date | C | 2,156,007 (d) | common stock 2,156,007 | $0.00 | 0 | indirect | by: scp couchbase acquisition, l.l.c. | ||
SERIES G PREFERRED STOCK | 0.0 | 2021-07-26 | deemed execution date | C | 1,024,048 (d) | common stock 1,092,385 | $0.00 | 0 | indirect | by: scp couchbase acquisition, l.l.c. |
ID | footnote |
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f1 | immediately prior to the completion of the issuer's initial public offering, each share of series f preferred stock is convertible into shares of the issuer's common stock, par value $0.00001 per share, on a one-for-one basis and has no expiration date. immediately prior to the completion of the issuer's initial public offering, each share of series g preferred stock is convertible into shares of the issuer's common stock, par value $0.00001 per share, on a 1.06673317089756-for-one basis and has no expiration date. |
f2 | sorenson capital partners iii, lp ("scp iii"), sorenson capital partners iii-a, lp ("scp iii-a"), sorenson capital partners iii-b, lp ("scp iii-b") and sorensen capital investment partner iii, lp ("scip iii") are the members of scp couchbase acquisition l.l.c. sorenson capital associates iii, lp is the general partner of each of scp iii, scp iii-a and scp iii-b. west rim capital advisors, lp is the general partner of scip iii. west rim capital advisors, llc ("west rim capital") is the general partner of each of sorenson capital associates iii, lp and west rim capital advisors, lp. rob rueckert is a member of the issuer's board of directors and the president of scp couchbase acquisition, l.l.c. each of mark ludwig, ron mika, rob rueckert and luke sorenson are partners of west rim capital and therefore may be deemed to have shared voting and dispositive power with respect to the shares held by scp couchbase acquisition l.l.c. |
f3 | (continuation of fn 2): each of the foregoing entities and individuals disclaim beneficial ownership of such shares except to the extent of their pecuniary interest therein. the address for each of the sorenson entities listed above is 3400 ashton boulevard #400, lehi, utah 84043. |