SEC Form 4 · accession 0001209191-17-041621

DETERMINE, INC. · DTRM

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Lloyd I Miller III

10% Owner

Period of report

Jun 21, 2017

Accepted (ET)

Jun 23, 2017 · 2:56 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001090908

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1	Jun 21, 2017	M	56,911	$5.70	A	766,728	I	By Trust A-4 - Lloyd I. Miller
Common Stock^F2,F1	Jun 21, 2017	J	72,847	—	A	839,575	I	By Trust A-4 - Lloyd I. Miller
Common Stock	Jun 21, 2017	M	56,911	$5.70	A	177,973	D
Common Stock^F2	Jun 21, 2017	J	72,847	—	A	250,820	D
Common Stock^F1	Jun 21, 2017	M	56,911	$5.70	A	1,280,469	I	By Milfam II L.P.
Common Stock^F3,F1	Jun 21, 2017	J	72,846	—	A	1,353,315	I	By Milfam II L.P.
Common Stock^F1	holding	—	—		—	334,590	I	By Trust C - Lloyd I. Miller
Common Stock^F1	holding	—	—		—	2,100	I	By Trust D - Lloyd I. Miller
Common Stock^F1	holding	—	—		—	211,351	I	By Milfam I L.P.

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Junior Secured Convertible Promissory Notes^F4,F5,F1,F6	$5.70	Jun 21, 2017	M	324,393	D	—	Dec 16, 2020	Common Stock	56,911	132,015	I
Junior Secured Convertible Promissory Notes^F4,F5,F6	$5.70	Jun 21, 2017	M	324,395	D	—	Dec 16, 2020	Common Stock	56,911	132,015	D
Junior Secured Convertible Promissory Notes^F4,F5,F1,F6	$5.70	Jun 21, 2017	M	324,395	D	—	Dec 16, 2020	Common Stock	56,911	132,015	I
Additional Extension Payment Shares^F7	—	holding	—	—	—	—	—	Common Stock	10,417	10,417	D
Additional Extension Payment Shares^F1,F7	—	holding	—	—	—	—	—	Common Stock	10,417	10,417	I
Junior Secured Convertible Promissory Note^F1	$3.00	holding	—	—	—	Dec 27, 2016	Dec 27, 2021	Common Stock	333,333	333,333	I
PIK Interest on Junior Secured Convertible Promissory Note^F1	$3.00	holding	—	—	—	Dec 27, 2016	Dec 27, 2021	Common Stock	10,342	10,342	I
Junior Secured Convertible Promissory Note	$3.00	holding	—	—	—	Dec 16, 2015	Dec 16, 2020	Common Stock	200,000	200,000	D
PIK Interest on Junior Secured Convertible Promissory Note	$3.00	holding	—	—	—	Dec 16, 2015	Dec 16, 2020	Common Stock	10,124	10,124	D
Junior Secured Convertible Promissory Note^F1	$3.00	holding	—	—	—	Dec 16, 2015	Dec 16, 2020	Common Stock	200,000	200,000	I
PIK Interest on Junior Secured Convertible Promissory Note^F1	$3.00	holding	—	—	—	Dec 16, 2015	Dec 16, 2020	Common Stock	10,124	10,124	I
Junior Secured Convertible Promissory Note^F1	$3.00	holding	—	—	—	Dec 16, 2015	Dec 16, 2020	Common Stock	200,000	200,000	I
PIK Interest on Junior Secured Convertible Promissory Note^F1	$3.00	holding	—	—	—	Dec 16, 2015	Dec 16, 2020	Common Stock	10,124	10,124	I
Warrant^F1,F8,F9	$6.00	holding	—	—	—	—	—	Common Stock	79,787	79,787	I
Warrant^F1,F8,F9	$6.00	holding	—	—	—	—	—	Common Stock	79,787	79,787	I
Warrant^F1,F8,F9	$6.00	holding	—	—	—	—	—	Common Stock	79,787	79,787	I
Warrant^F1	$7.00	holding	—	—	—	Aug 27, 2014	Aug 27, 2019	Common Stock	49,401	49,401	I
Warrant^F1	$7.00	holding	—	—	—	Aug 27, 2014	Aug 27, 2019	Common Stock	13,722	13,722	I
Warrant^F1	$7.00	holding	—	—	—	Aug 27, 2014	Aug 27, 2019	Common Stock	74,102	74,102	I
Warrant^F1	$7.00	holding	—	—	—	Jul 24, 2014	Jul 24, 2019	Common Stock	57,558	57,558	I
Warrant^F1	$7.00	holding	—	—	—	Jul 24, 2014	Jul 24, 2019	Common Stock	15,988	15,988	I
Warrant^F1	$7.00	holding	—	—	—	Jul 24, 2014	Jul 24, 2019	Common Stock	86,338	86,338	I
Series A Warrant^F1	$7.75	holding	—	—	—	Dec 1, 2013	May 31, 2018	Common Stock	40,894	40,894	I
Series A Warrant^F1	$7.75	holding	—	—	—	Dec 1, 2013	May 31, 2018	Common Stock	11,359	11,359	I
Series A Warrant^F1	$7.75	holding	—	—	—	Dec 1, 2013	May 31, 2018	Common Stock	61,342	61,342	I

Explanation of responses

F1The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. This filing shall not be deemed an admission that the reporting person is, for purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, the beneficial owner of any equity securities covered by this filing.
F2Shares of common stock referenced in this line item were received by the Reporting Person from the Issuer as an inducement to convert $324,395.00 of outstanding interest and principal payable under junior secured convertible promissory notes into 56,911 shares of common stock.
F3Shares of common stock referenced in this line item were received by the Reporting Person from the Issuer as an inducement to convert $324,392.50 of outstanding interest and principal payable under junior secured convertible promissory notes into 56,911 shares of common stock.
F4Includes all previously reported PIK Interest on Junior Secured Convertible Promissory Note
F5As previously reported, the issuer entered into a binding term sheet with the reporting person pursuant to which the issuer agreed to issue and the reporting person agreed to purchase, junior secured convertible promissory notes in the aggregate principal amount of $3 million subject to negotiation and execution of definitive documentation. On March 11, 2015, the notes were executed and on May 5, 2015, the shareholders approved the conversion of the notes at the stockholders meeting.
F6Subject to adjustment for fractional shares.
F7Pursuant to the Guaranty Fee Agreement, in the event that the maturity date of April 30, 2019 is extended, which extended termination date shall be no later than July 30, 2020, the Issuer agrees to pay Lloyd I. Miller, III and Milfam II L.P. the shares of common stock referenced herein.
F8Such Warrant will be exercisable six months following the date of issuance, February 6, 2015.
F9Such Warrant will expire on the fifth anniversary of the exercisability date.