- Statement of Changes in Beneficial Ownership (4)
01 Março 2012 - 9:38PM
Edgar (US Regulatory)
FORM 4
[ ]
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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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(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
NBGE Manager, LLC
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2. Issuer Name
and
Ticker or Trading Symbol
Proto Labs Inc
[
PRLB
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
C/O NORTH BRIDGE GROWTH EQUITY, 950 WINTER STREET, SUITE 4600
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3. Date of Earliest Transaction
(MM/DD/YYYY)
2/29/2012
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(Street)
WALTHAM, MA 02454
(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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2/29/2012
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C
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5991790
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A
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(1)
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5991790
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I
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By North Bridge Growth Equity I, L.P.
(2)
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Common Stock
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2/29/2012
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P
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430000
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A
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$16
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6421790
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I
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By North Bridge Growth Equity I, L.P.
(2)
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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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Series A Preferred Stock
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(1)
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2/29/2012
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C
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427985
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(1)
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(3)
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Common Stock
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5991790
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$
0
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0
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I
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By North Bridge Growth Equity I, L.P.
(2)
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Explanation of Responses:
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(
1)
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Upon the closing of the Issuer's initial public offering, each of the 427,985 shares of Series A Preferred Stock automatically converted into shares of the Issuer's Common Stock on a 14-for-1 basis.
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(
2)
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Represents shares held directly by North Bridge Growth Equity I, L.P. NBGE Manager, LLC ("NBGE") is the managing manager of NBGE GP, LLC, which is the sole general partner of North Bridge Growth Management, L.P., which is the sole general partner of North Bridge Growth Equity I, L.P. NBGE has sole vesting and dispositive power over such shares. Douglas Kingsley, a director of the Issuer, is a founding managing director of NBGE GP, LLC. Shared voting and investment power over such shares is vested in the managers of NBGE, Edward Anderson and Richard D'Amore. Mr. Kingsley, Mr. Anderson and Mr. D'Amore each disclaim any beneficial ownership of such shares, except to the extent of any pecuniary interest therein. This report shall not be deemed an admission that any of the reporting persons is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
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(
3)
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The security does not have an expiration date.
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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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NBGE Manager, LLC
C/O NORTH BRIDGE GROWTH EQUITY
950 WINTER STREET, SUITE 4600
WALTHAM, MA 02454
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X
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X
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ANDERSON EDWARD T
C/O NORTH BRIDGE GROWTH EQUITY
950 WINTER STREET, SUITE 4600
WALTHAM, MA 02454
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X
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DAMORE RICHARD A
C/O NORTH BRIDGE GROWTH EQUITY
950 WINTER STREET, SUITE 4600
WALTHAM, MA 02454
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X
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KINGSLEY DOUGLAS A
C/O NORTH BRIDGE GROWTH EQUITY
950 WINTER STREET, SUITE 4600
WALTHAM, MA 02454
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X
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NBGE GP, LLC
C/O NORTH BRIDGE GROWTH EQUITY
950 WINTER STREET, SUITE 4600
WALTHAM, MA 02454
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X
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NORTH BRIDGE GROWTH EQUITY I LP
C/O NORTH BRIDGE GROWTH EQUITY
950 WINTER STREET, SUITE 4600
WALTHAM, MA 02454
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X
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North Bridge Growth Management, L.P.
C/O NORTH BRIDGE GROWTH EQUITY
950 WINTER STREET, SUITE 4600
WALTHAM, MA 02454
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X
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Signatures
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/c/ Catherine M. Verschelden, Attorney-in-Fact for NBGE Manager, LLC
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3/1/2012
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**
Signature of Reporting Person
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Date
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/s/ Catherine M. Verschelden, Attorney-in-Fact for Edward Anderson
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3/1/2012
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**
Signature of Reporting Person
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Date
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/s/ Catherine M. Verschelden, Attorney-in-Fact for Richard D'Amore
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3/1/2012
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**
Signature of Reporting Person
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Date
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/s/ Catherine M. Verschelden, Attorney-in-Fact for Douglas Kingsley
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3/1/2012
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**
Signature of Reporting Person
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Date
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/s/ Catherine M. Verschelden, Attorney-in-Fact for NBGE GP, LLC
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3/1/2012
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**
Signature of Reporting Person
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Date
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/s/ Catherine M. Verschelden, Attorney-in-Fact for North Bridge Growth Equity I, L.P.
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3/1/2012
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**
Signature of Reporting Person
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Date
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/s/ Catherine M. Verschelden, Attorney-in-Fact for North Bridge Growth Management, L.P.
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3/1/2012
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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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