- Statement of Changes in Beneficial Ownership (4)
April 22 2011 - 5:19PM
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
Expires:
February 28, 2011
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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
*
Charter Legacy, LLC
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2. Issuer Name
and
Ticker or Trading Symbol
ELLIE MAE INC
[
ELLI
]
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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)
C/O C.M. CAPITAL CORP., 525 UNIVERSITY AVENUE, SUITE 1400
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3. Date of Earliest Transaction
(MM/DD/YYYY)
4/20/2011
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(Street)
PALO ALTO, CA 94301
(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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4/20/2011
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C
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666666
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A
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(1)
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666666
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I
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See footnote
(2)
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Common Stock
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4/20/2011
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C
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637586
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A
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(1)
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1304252
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I
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See footnote
(2)
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Common Stock
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4/20/2011
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C
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160133
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A
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(1)
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1464385
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I
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See footnote
(2)
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Common Stock
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4/20/2011
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C
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296622
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A
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(1)
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1761007
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I
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See footnote
(2)
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Common Stock
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4/20/2011
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C
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363373
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A
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(1)
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2124380
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I
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See footnote
(2)
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Common Stock
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4/20/2011
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C
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163539
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A
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(1)
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2287919
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I
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See footnote
(2)
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Common Stock
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4/20/2011
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X
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83333
(3)
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A
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$3
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2371252
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I
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See footnote
(2)
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Common Stock
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4/20/2011
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S
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41667
(3)
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D
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$6
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2329585
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I
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See footnote
(2)
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Common Stock
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4/20/2011
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S
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553841
(4)
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D
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$6
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1775744
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I
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See footnote
(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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4/20/2011
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C
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666666
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(1)
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(1)
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Common Stock
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666666
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(1)
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0
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I
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See footnote
(2)
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Series B Preferred Stock
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(1)
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4/20/2011
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C
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637586
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(1)
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(1)
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Common Stock
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637586
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(1)
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0
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I
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See footnote
(2)
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Series C Preferred Stock
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(1)
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4/20/2011
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C
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160133
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(1)
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(1)
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Common Stock
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160133
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(1)
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0
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I
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See footnote
(2)
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Series D Preferred Stock
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(1)
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4/20/2011
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C
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296622
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(1)
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(1)
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Common Stock
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296622
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(1)
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0
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I
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See footnote
(2)
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Series E Preferred Stock
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(1)
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4/20/2011
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C
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363373
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(1)
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(1)
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Common Stock
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363373
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(1)
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0
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I
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See footnote
(2)
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Series F Preferred Stock
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(1)
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4/20/2011
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C
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163539
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(1)
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(1)
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Common Stock
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163539
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(1)
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0
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I
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See footnote
(2)
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Common Stock Warrant
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$3
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4/20/2011
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X
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17730
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7/13/2001
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(5)
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Common Stock
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17730
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$3
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0
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I
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See footnote
(2)
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Common Stock Warrant
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$3
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4/20/2011
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X
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17730
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8/15/2001
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(5)
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Common Stock
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17730
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$3
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0
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I
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See footnote
(2)
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Common Stock Warrant
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$3
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4/20/2011
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X
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47873
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10/1/2001
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(5)
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Common Stock
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47783
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$3
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0
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I
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See footnote
(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 on April 20, 2011, each share of Series A Preferred Stock, Series B Preferred Stock, Series C Preferred Stock, Series D Preferred Stock, Series E Preferred Stock, and Series F Preferred Stock (collectively, the "Preferred Shares") converted automatically into shares of the Issuer's Common Stock. The Preferred Shares converted on a one-to-one basis into Common Stock, without payment of additional consideration. The Preferred Shares were convertible at any time, at the holder's election, and automatically upon consummation of the Issuer's initial public offering and had no expiration date.
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(
2)
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The reported securities are held of record by Charter Legacy, LLC. Charter Legacy, LLC is a wholly owned investment vehicle of the CMC Master Fund, L.P. C.M. Capital Advisors, LLC is the fund manager of CMC Master Fund, L.P. and the manager of Charter Legacy, LLC. The sole member of C.M. Capital Advisors, LLC is C.M. Capital Corp.
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(
3)
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These shares reflect the combined net exercise of the warrants for Common Stock pursuant to the terms of the warrants into 41,666 shares of the Issuer's Common Stock.
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(
4)
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Shares sold as part of the initial public offering, including shares sold as part of the partial exercise of the underwriters' overallotment option.
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(
5)
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Pursuant to their terms, the warrants would terminate at the closing of the Issuer's initial public offering. The holder elected to net exercise the warrants contingent upon and effective immediately prior to the closing of the Issuer's initial public offering of Common Stock.
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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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Charter Legacy, LLC
C/O C.M. CAPITAL CORP.
525 UNIVERSITY AVENUE, SUITE 1400
PALO ALTO, CA 94301
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X
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CMC Master Fund, L.P.
C/O C.M. CAPITAL CORP.
525 UNIVERSITY AVENUE, SUITE 1400
PALO ALTO, CA 94301
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X
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C.M. Capital Advisors, LLC
C/O C.M. CAPITAL CORP.
525 UNIVERSITY AVENUE, SUITE 1400
PALO ALTO, CA 94301
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X
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C.M. Capital Corp
525 UNIVERSITY AVENUE, SUITE 1400
PALO ALTO, CA 94301
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X
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Signatures
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/s/ Elizabeth Hammack, Authorized Officer
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4/21/2011
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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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