Statement of Changes in Beneficial Ownership (4)
June 25 2015 - 12:48PM
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 APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
Clavier Jean-Francois
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2. Issuer Name
and
Ticker or Trading Symbol
FITBIT INC
[
FIT
]
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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 SOFTTECH VC, 530 LYTTON AVE., 2ND FLOOR
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3. Date of Earliest Transaction
(MM/DD/YYYY)
6/23/2015
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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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Class A Common Stock
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6/23/2015
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C
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37500
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A
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$0.00
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37500
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I
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By SoftTech VC II, L.P
(3)
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Class A Common Stock
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6/23/2015
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S
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37500
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D
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$18.80
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0
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I
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By SoftTech VC II, L.P
(3)
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Class A Common Stock
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6/23/2015
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C
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112500
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A
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$0.00
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112500
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I
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By SoftTech VC III, L.P
(4)
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Class A Common Stock
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6/23/2015
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S
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112500
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D
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$18.80
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0
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I
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By SoftTech VC III, L.P
(4)
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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-1 Convertible Preferred Stock
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(1)
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6/23/2015
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C
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1363956
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(1)
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(1)
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Class B Common Stock
(2)
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1363956
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$0.00
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0
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I
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By SoftTech VC II, L.P.
(3)
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Class B Common Stock
(2)
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(2)
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6/23/2015
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C
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1363956
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(2)
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(2)
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Class A Common Stock
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1363956
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$0.00
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1363956
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I
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By SoftTech VC II, L.P.
(3)
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Series B Convertible Preferred Stock
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(1)
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6/23/2015
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C
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387936
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(1)
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(1)
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Class B Common Stock
(2)
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387936
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$0.00
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0
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I
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By SoftTech VC II, L.P.
(3)
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Class B Common Stock
(2)
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(2)
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6/23/2015
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C
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387936
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(2)
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(2)
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Class A Common Stock
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387936
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$0.00
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1751892
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I
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By SoftTech VC II, L.P.
(3)
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Series C Convertible Preferred Stock
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(1)
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6/23/2015
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C
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644328
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(1)
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(1)
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Class B Common Stock
(2)
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644328
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$0.00
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0
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I
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By SoftTech VC II, L.P.
(3)
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Class B Common Stock
(2)
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(2)
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6/23/2015
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C
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644328
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(2)
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(2)
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Class A Common Stock
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644328
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$0.00
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2396220
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I
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By SoftTech VC II, L.P.
(3)
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Class B Common Stock
(2)
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(2)
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6/23/2015
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C
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37500
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(2)
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(2)
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Class A Common Stock
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37500
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$0.00
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2358720
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I
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By SoftTech VC II, L.P.
(3)
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Series B Convertible Preferred Stock
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(1)
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6/23/2015
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C
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1251156
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(1)
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(1)
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Class B Common Stock
(2)
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1251156
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$0.00
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0
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I
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By SoftTech VC III, L.P.
(4)
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Class B Common Stock
(2)
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(2)
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6/23/2015
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C
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1251156
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(2)
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(2)
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Class A Common Stock
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1251156
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$0.00
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1251156
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I
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By SoftTech VC III, L.P.
(4)
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Series C Convertible Preferred Stock
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(1)
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6/23/2015
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C
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2552712
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(1)
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(1)
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Class B Common Stock
(2)
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2552712
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$0.00
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0
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I
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By SoftTech VC III, L.P.
(4)
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Class B Common Stock
(2)
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(2)
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6/23/2015
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C
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2552712
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(2)
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(2)
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Class A Common Stock
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2552712
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$0.00
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3803868
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I
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By SoftTech VC III, L.P.
(4)
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Class B Common Stock
(2)
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(2)
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6/23/2015
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C
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112500
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(2)
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(2)
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Class A Common Stock
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112500
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$0.00
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3691368
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I
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By SoftTech VC III, L.P.
(3)
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Explanation of Responses:
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(
1)
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The Convertible Preferred Stock automatically converted into Class B Common Stock on a one-for-one basis immediately prior to the completion of the Issuer's initial public offering and has no expiration date.
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(
2)
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Each share of Class B Common Stock is convertible at any time at the option of the Reporting Person into one share of Class A Common Stock and has no expiration date. The Class B Common Stock will convert automatically into Class A Common Stock on the same basis upon the earlier of: (i) any transfer, whether or not for value, except for certain "Permitted Transfers" as defined in the Issuer's restated certificate of incorporation in effect as of the date hereof, (ii) the affirmative vote of the holders of Class B Common Stock representing not less than a majority of the outstanding shares of Class B Common Stock, or (iii) June 17, 2027.
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(
3)
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Shares are held directly by SoftTech VC II, L.P. SoftTech VC II, L.L.C. is the general partner of SoftTech II, L.P. Jean-Francois Clavier is the managing member of SoftTech II, L.L.C. and has sole voting and dispositive power over the shares held by SoftTech II, L.P.
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(
4)
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Shares are held directly by SoftTech VC III, L.P. SoftTech VC III, L.L.C. is the general partner of SoftTech III, L.P. Jean-Francois Clavier is the managing member of SoftTech III, L.L.C. and has sole voting and dispositive power over the shares held by SoftTech III, L.P.
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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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Clavier Jean-Francois
C/O SOFTTECH VC
530 LYTTON AVE., 2ND FLOOR
PALO ALTO, CA 94301
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X
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SoftTech VC II LP
530 LYTTON AVE., 2ND FLOOR
PALO ALTO, CA 94301
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X
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SoftTech VC II, L.L.C.
530 LYTTON AVE., 2ND FLOOR
PALO ALTO, CA 94301
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X
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SoftTech VC III, L.P.
530 LYTTON AVE., 2ND FLOOR
PALO ALTO, CA 94301
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X
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SoftTech VC III, L.L.C.
530 LYTTON AVE., 2ND FLOOR
PALO ALTO, CA 94301
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X
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Signatures
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/s/ Jean-Francois Clavier
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6/23/2015
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**
Signature of Reporting Person
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Date
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SoftTech VC II, L.L.C./s/ Jean-Francois Clavier as Managing Member
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6/23/2015
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**
Signature of Reporting Person
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Date
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SoftTech VC II, L.P./s/ Jean-Francois Clavier as Managing Member of SoftTech VC II, L.L.C., its general partner
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6/23/2015
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**
Signature of Reporting Person
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Date
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SoftTech VC III, L.L.C./s/ Jean-Francois Clavier as Managing Member
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6/23/2015
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**
Signature of Reporting Person
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Date
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SoftTech VC III, L.P./s/ Jean-Francois Clavier as Managing Member of SoftTech VC III, L.L.C., its general partner
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6/23/2015
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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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