Statement of Changes in Beneficial Ownership (4)
04 Dezembro 2015 - 7:08PM
Edgar (US Regulatory)
FORM 4
[
X
]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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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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1. Name and Address of Reporting Person
*
Partech U.S. Partners IV, L.L.C.
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2. Issuer Name
and
Ticker or Trading Symbol
Five9, Inc.
[
FIVN
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
200 CALIFORNIA ST., STE 500
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3. Date of Earliest Transaction
(MM/DD/YYYY)
12/2/2015
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(Street)
SAN FRANCISCO, CA 94111
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
___ Form filed by One Reporting Person
_
X
_ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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3510983
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D
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Common Stock
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12/2/2015
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J
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678128
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D
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$0.00
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0
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I
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By Partech International Growth Capital I L.L.C.
(1)
(2)
(3)
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Common Stock
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12/2/2015
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J
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1117124
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D
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$0.00
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0
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I
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By Partech International Growth Capital II L.L.C.
(1)
(2)
(3)
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Common Stock
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12/2/2015
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J
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678130
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D
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$0.00
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0
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I
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By Partech International Growth Capital III L.L.C.
(1)
(2)
(3)
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Common Stock
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12/2/2015
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J
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276103
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D
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$0.00
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0
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I
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By AXA Growth Capital II L.P.
(1)
(2)
(3)
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Common Stock
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24580
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I
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By 45th Parallel L.L.C.
(1)
(2)
(3)
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Common Stock
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24580
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I
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By Par SF II, L.L.C.
(1)
(2)
(3)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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Vincent R. Worms is (A) the sole member of Par SF II L.L.C. ("Par SF"), (B) the managing member of 47th Parallel, L.L.C. ("47th Parallel"), which is the managing member of Partech U.S. Partners IV, L.L.C. ("Partech US"), (C) the managing member of 45th Parallel L.L.C. ("45th Parallel"), which is the managing member of 46th Parallel L.L.C. ("46th Parallel"), which is the managing member of Partech International Growth Capital I L.L.C. ("Partech I"), Partech International Growth Capital II L.L.C.("Partech II") and Partech International Growth Capital III L.L.C. ("Partech III")
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(
2)
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(Continued from footnote1) and (D) the managing member of 48th Parallel L.L.C. ("48th Parallel"), which is the investment general partner of AXA Growth Capital II L.P. ("AXA").
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(
3)
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Vincent R. Worms may be deemed to have voting control and investment power over the securities held by Par SF, Partech US, 45th Parallel, Partech I, Partech II, Partech III and AXA, but disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
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Remarks:
Form 2 of 2
Five9, Inc. shares were distributed out to various partners by Partech I, Partech II, Partech III and AXA.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Partech U.S. Partners IV, L.L.C.
200 CALIFORNIA ST., STE 500
SAN FRANCISCO, CA 94111
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X
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WORMS VINCENT
200 CALIFORNIA ST., STE 500
SAN FRANCISCO, CA 94111
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X
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Signatures
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/s/ Vincent R. Worms, managing member of 47th Parallel, L.L.C., the managing member of the Reporting Person
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12/4/2015
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**
Signature of Reporting Person
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Date
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/s/ Vincent R. Worms
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12/4/2015
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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