Form 4 Couchbase, Inc. For: Jul 26 Filed by: DAMORE RICHARD A
FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person
*
(Street)
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2. Issuer Name
and
Ticker or Trading Symbol
Couchbase, Inc. [ BASE ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 07/26/2021 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check
Applicable Line)
|
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 07/26/2021 | C | 2,402,147 | A | (1) | 2,594,381 | I | By: North Bridge Venture Partners 7, L.P. (2) | ||
Common Stock | 07/26/2021 | C | 1,864,081 | A | (1) | 1,946,459 | I | By: North Bridge Venture Partners VI, L.P. (3) | ||
Common Stock | 07/26/2021 | P | 94,791 (4) | A | $ 24 | 2,689,172 | I | By: North Bridge Venture Partners 7, L.P. (2) | ||
Common Stock | 07/26/2021 | P | 40,625 (5) | A | $ 24 | 1,987,084 | I | By: North Bridge Venture Partners VI, L.P. (3) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 Securities Underlying Derivative Security (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: 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 | (1) | 07/26/2021 | C | 643,708 | (1) | (1) | Common Stock | 643,708 | $ 0 | 0 | I | By: North Bridge Venture Partners 7, L.P. (2) | |||
Series A Preferred Stock | (1) | 07/26/2021 | C | 643,708 | (1) | (1) | Common Stock | 643,708 | $ 0 | 0 | I | By: North Bridge Venture Partners VI, L.P. (3) | |||
Series B Preferred Stock | (1) | 07/26/2021 | C | 498,927 | (1) | (1) | Common Stock | 498,927 | $ 0 | 0 | I | By: North Bridge Venture Partners 7, L.P. (2) | |||
Series B Preferred Stock | (1) | 07/26/2021 | C | 498,927 | (1) | (1) | Common Stock | 498,927 | $ 0 | 0 | I | By: North Bridge Venture Partners VI, L.P. (3) | |||
Series C Preferred Stock | (1) | 07/26/2021 | C | 317,901 | (1) | (1) | Common Stock | 317,901 | $ 0 | 0 | I | By: North Bridge Venture Partners 7, L.P. (2) | |||
Series C Preferred Stock | (1) | 07/26/2021 | C | 317,901 | (1) | (1) | Common Stock | 317,901 | $ 0 | 0 | I | By: North Bridge Venture Partners VI, L.P. (3) | |||
Series D Preferred Stock | (1) | 07/26/2021 | C | 201,031 | (1) | (1) | Common Stock | 201,031 | $ 0 | 0 | I | By: North Bridge Venture Partners 7, L.P. (2) | |||
Series D Preferred Stock | (1) | 07/26/2021 | C | 86,156 | (1) | (1) | Common Stock | 86,156 | $ 0 | 0 | I | By: North Bridge Venture Partners VI, L.P. (3) | |||
Series E Preferred Stock | (1) | 07/26/2021 | C | 93,999 | (1) | (1) | Common Stock | 98,962 | $ 0 | 0 | I | By: North Bridge Venture Partners 7, L.P. (2) | |||
Series E Preferred Stock | (1) | 07/26/2021 | C | 40,285 | (1) | (1) | Common Stock | 42,411 | $ 0 | 0 | I | By: North Bridge Venture Partners VI, L.P. (3) | |||
Series F Preferred Stock | (1) | 07/26/2021 | C | 131,840 | (1) | (1) | Common Stock | 131,840 | $ 0 | 0 | I | By: North Bridge Venture Partners 7, L.P. (2) | |||
Series F Preferred Stock | (1) | 07/26/2021 | C | 56,502 | (1) | (1) | Common Stock | 56,502 | $ 0 | 0 | I | By: North Bridge Venture Partners VI, L.P. (3) | |||
Series G Preferred Stock | (1) | 07/26/2021 | C | 477,888 | (1) | (1) | Common Stock | 509,778 | $ 0 | 0 | I | By: North Bridge Venture Partners 7, L.P. (2) | |||
Series G Preferred Stock | (1) | 07/26/2021 | C | 204,809 | (1) | (1) | Common Stock | 218,476 | $ 0 | 0 | I | By: North Bridge Venture Partners VI, L.P. (3) |
NBVM GP, LLC, /s/ Edward T. Anderson, Managing Member of NBVM GP | 07/26/2021 | |
** Signature of Reporting Person | Date | |
North Bridge Venture Partners 7, L.P., /s/ Edward T. Anderson, Managing Member of NBVM GP, general partner of North Bridge Venture Management 7, L.P., general partner of North Bridge Venture Partners 7, L.P. | 07/26/2021 | |
** Signature of Reporting Person | Date | |
/s/ Richard A. D'Amore | 07/26/2021 | |
** Signature of Reporting Person | Date | |
North Bridge Venture Partners VI, L.P., /s/ Edward T. Anderson, Managing Member of NBVM GP, general partner of North Bridge Venture Management VI, L.P., general partner of North Bridge Venture Partners VI, L.P. | 07/26/2021 | |
** Signature of Reporting Person | Date | |
North Bridge Venture Management VI, L.P., /s/ Edward T. Anderson, Managing Member of NBVM GP, general partner of North Bridge Venture Management VI, L.P. | 07/26/2021 | |
** Signature of Reporting Person | Date | |
North Bridge Venture Management 7, L.P., /s/ Edward T. Anderson, Managing Member of NBVM GP, general partner of North Bridge Venture Management V, L.P. | 07/26/2021 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* 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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |
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