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 | ||||
Series A Preferred Stock | (3) | (3) | Common Stock | 27,826 | $ (3) | I | By Gen 3 Partners, Inc. (2) |
Series B Preferred Stock | (3) | (3) | Common Stock | 82,416 | $ (3) | I | By Gen 3 Partners, Inc. (2) |
Series C Preferred Stock | (3) | (3) | Common Stock | 39,697 | $ (3) | I | By Gen 3 Partners, Inc. (2) |
Series D Preferred Stock | (3) | (3) | Common Stock | 12,309 | $ (3) | I | By Gen 3 Partners, Inc. (2) |
Series E Preferred Stock | (3) | (3) | Common Stock | 157,515 | $ (3) | I | By GEN3 Capital I, LP (2) |
Series F Preferred Stock | (3) | (3) | Common Stock | 96,899 | $ (3) | I | By GEN3 Capital I, LP (2) |
Series G Preferred Stock | (3) | (3) | Common Stock | 383,995 | $ (3) | I | By GEN3 Capital I, LP (2) |
Dividend Right | (4) | (4) | Common Stock | 33,972 | $ (4) | I | By Gen 3 Partners, Inc. (2) |
Dividend Right | (4) | (4) | Common Stock | 351,051 | $ (4) | I | By GEN3 Capital I, LP (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
GEN3 Capital Partners, LLC C/O AIRGAIN, INC. 3611 VALLEY CENTRE DRIVE, SUITE 150 SAN DIEGO, CA 92130 |
X | |||
GEN3 Capital I L P C/O AIRGAIN, INC. 3611 VALLEY CENTRE DRIVE, SUITE 150 SAN DIEGO, CA 92130 |
X | |||
GEN 3 PARTNERS INC C/O AIRGAIN, INC. 3611 VALLEY CENTRE DRIVE, SUITE 150 SAN DIEGO, CA 92130 |
X |
GEN3 Capital Partners, LLC By: /s/ Haydar Diab, Vice President | 08/11/2016 | |
**Signature of Reporting Person | Date | |
GEN3 Capital I, LP By: GEN3 Capital Partners, LLC, its general partner By: /s/ Haydar Diab, Vice President | 08/11/2016 | |
**Signature of Reporting Person | Date | |
Gen 3 Partners, Inc. By: /s/ Haydar Diab, Vice President | 08/11/2016 | |
**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) | Represents 51,244 shares of common stock held by GEN3 Capital I, LP ("GEN3 Capital") and 166,358 shares of common stock held by Gen 3 Partners, Inc. ("Gen 3 Partners"). |
(2) | The general partner of GEN3 Capital is GEN3 Capital Partners, LLC ("GEN3 LLC"), and Jim K. Sims is the Managing Member of of GEN3 LLC. As a result, each of GEN3 LLC and Mr. Sims may be deemed to share beneficil ownership of the shares held by GEN3 Capital. Mr. Sims, Francis X. Egan, Arthur M. Toscanini and Michael Treacy may be deemed to share beneficial ownership of the shares held by Gen 3 Partners in their capacity as directors of Gen 3 Partners. Each of the individuals and entities listed herein disclaims such beneficial ownership extent to the extent of his or its pecuniary interest therein. |
(3) | The preferred stock is convertible at any time, at the holder's election and has no expiration date. The preferred stock will automatically convert into common stock upon the closing of the Issuer's initial public offering. |
(4) | The dividend rights are payable in cash or shares of common stock at the Issuer's election immediately upon the closing of the Issuer's initial public offering. |