|
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
|
| |||||||||||||||||||||||||||||
|
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) |
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) |
||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series A Preferred Stock | (2) | 05/29/2013 | C | 15,400,559 | (2) | (2) | Common Stock | 962,534 (3) | $ 0 | 0 | D | ||||
Series B Preferred Stock | (2) | 05/29/2013 | C | 1,806,277 | (2) | (2) | Common Stock | 112,892 (3) | $ 0 | 0 | D | ||||
Series B-1 Preferred Stock | (2) | 05/29/2013 | C | 335,959 | (2) | (2) | Common Stock | 20,997 (3) | $ 0 | 0 | D | ||||
Warrant to Purchase Series C Preferred Stock (right to buy) | $ 0.685 | 05/29/2013 | X | 72,992 | 05/30/2008 | (4) | Series C Preferred Stock | 72,992 | $ 0 | 0 | D | ||||
Series C Preferred Stock | (2) | 05/29/2013 | X | 72,992 | (2) | (2) | Common Stock | 4,562 (3) | $ 0.685 | 1,344,324 | D | ||||
Series C Preferred Stock | (2) | 05/29/2013 | S(5) | 57,143 | (2) | (2) | Common Stock | 3,571 (3) | $ 0.875 | 1,287,181 | D | ||||
Series C Preferred Stock | (2) | 05/29/2013 | C | 1,287,181 | (2) | (2) | Common Stock | 80,448 (3) | $ 0 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
BUINEVICIUS ARIS ANTANAS C/O CHANNELADVISOR CORPORATION 2701 AERIAL CENTER PARKWAY MORRISVILLE, NC 27560 |
X | Chief Technology Officer |
/s/ Brian F. Leaf, Attorney-in-fact | 05/29/2013 | |
**Signature of Reporting Person | Date |
* | 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) | The total represents shares received upon conversion of shares of Series A, Series B, Series B-1 and Series C convertible preferred stock. |
(2) | Each share of convertible preferred stock was convertible, at any time, at the holder's election, into the issuer's common stock on a 1-for-16 basis. Effective immediately prior to the closing of the issuer's initial public offering of its common stock, each share of convertible preferred stock automatically converted into one-sixteenth of one share of common stock. The convertible preferred stock had no expiration date. |
(3) | The number of underlying shares of common stock reported reflects a 1-for-16 reverse stock split of the issuer's common stock effected on May 9, 2013. |
(4) | This warrant expires upon an initial public offering of the issuer's securities. |
(5) | On May 29, 2013, the reporting person exercised a warrant to purchase 72,992 shares of the issuer's Series C convertible preferred stock for $0.685 per share. The reporting person paid the exercise price on a cashless basis, resulting in the issuer's withholding of 57,143 of the Series C convertible preferred shares to pay the exercise price and issuing to the reporting person the remaining 15,849 shares of Series C convertible preferred stock. |