- Statement of Changes in Beneficial Ownership (4)
April 22 2011 - 6:04PM
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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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
*
CORELOGIC, INC.
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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)
4 FIRST AMERICAN WAY
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3. Date of Earliest Transaction
(MM/DD/YYYY)
4/20/2011
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(Street)
SANTA ANA, CA 92707
(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)
_
X
_ Form filed by One Reporting Person
___ 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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416666
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A
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(2)
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416666
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I
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See footnote
(1)
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Common Stock
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4/20/2011
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C
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2092050
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A
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(2)
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2508716
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I
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See footnote
(1)
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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 E Convertible Preferred Stock
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(2)
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4/20/2011
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C
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416666
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(2)
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(2)
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Common Stock
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416666
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(2)
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0
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I
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See footnote
(1)
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Series G Convertible Preferred Stock
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(2)
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4/20/2011
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C
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2092050
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(2)
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(2)
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Common Stock
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2092050
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(2)
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0
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I
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See footnote
(1)
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Explanation of Responses:
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(
1)
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The securities are held directly by CoreLogic Real Estate Information Services, LLC, which is a wholly-owned subsidiary of CoreLogic, Inc. CoreLogic Real Estate Information Services, LLC, along with CoreLogic, Inc., exercise shared voting and investment power with respect to such securities. These securities are beneficially owned by CoreLogic Real Estate Information Services, LLC.
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(
2)
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Upon the closing of the Issuer's initial public offering on April 20, 2011, each share of Series E Convertible Preferred Stock and each share of Series G Convertible Preferred Stock (collectively, the "Convertible Stock") automatically converted into shares of the Issuer's Common Stock. The shares of Convertible Stock converted on a 1:1 basis into Common Stock, without the payment of additional consideration and had no 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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CORELOGIC, INC.
4 FIRST AMERICAN WAY
SANTA ANA, CA 92707
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X
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Signatures
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/s/ Corinna Cherian, Vice President, Associate General Counsel and Assistant Secretary of CoreLogic, Inc.
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4/22/2011
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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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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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