SEC Form 4 · accession 0001209191-19-000789

DETERMINE, INC. · DTRM

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

Reporting owner

10% Owner

Period of report

Dec 31, 2018

Accepted (ET)

Jan 3, 2019 · 2:39 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001090908

Table I — non-derivative securities

Security	Date	Code	Shares	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F2	holding	—	—	—	1,326,315	I	By Milfam II L.P.
Common Stock^F1,F2	holding	—	—	—	354,789	I	By LIM III - Trust A-4
Common Stock^F1,F2	holding	—	—	—	354,786	I	By MBM - Trust A-4
Common Stock^F1,F2	holding	—	—	—	301,590	I	By Trust C - Lloyd I. Miller
Common Stock^F1,F2	holding	—	—	—	211,351	I	By Milfam I L.P.
Common Stock^F1,F2	holding	—	—	—	2,100	I	By Trust D - Lloyd I. Miller
Common Stock^F1,F2	holding	—	—	—	250,820	I	By Lloyd I. Miller, III Revocable Trust

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Junior Secured Convertible Promissory Note and PIK Interest^{F4,F1,F2,F3,F5}	$3.00	Dec 31, 2018	J	17,999	A	Dec 16, 2015	Dec 16, 2020	Common Stock	5,999	249,378	I
Junior Secured Convertible Promissory Note and PIK Interest^{F4,F1,F2,F3,F5}	$3.00	Dec 31, 2018	J	17,999	A	Dec 16, 2015	Dec 16, 2020	Common Stock	5,999	249,378	I
Junior Secured Convertible Promissory Note and PIK Interest^{F4,F1,F2,F3,F5}	$3.00	Dec 31, 2018	J	9,000	A	Dec 16, 2015	Dec 16, 2020	Common Stock	2,999	124,686	I
Junior Secured Convertible Promissory Note and PIK Interest^{F4,F1,F2,F3,F5}	$3.00	Dec 31, 2018	J	9,000	A	Dec 16, 2015	Dec 16, 2020	Common Stock	2,999	124,686	I
Junior Secured Convertible Promissory Note and PIK Interest^{F4,F1,F2,F3,F5}	$3.00	Dec 31, 2018	J	36,172	A	Dec 27, 2016	Dec 27, 2021	Common Stock	12,057	421,658	I

F1Except for possessing voting and dispositive power, the reporting person disclaims any other beneficial ownership of, and specifically any pecuniary interest in, the securities reported herein. This filing is not, and shall not be deemed, an admission (and the reporting person expressly disclaims) that the reporting person is, for purposes of Rule 16a-1(a)(2) under Section 16 of the Securities Exchange Act of 1934, the beneficial owner of any equity securities covered by this filing.
F2Mr. Neil Subin succeeded to the position of President and Manager of MILFAM LLC, which serves as manager, general partner, or investment advisor of a number of entities formerly managed or advised by the late Lloyd I. Miller, III. Mr. Subin also serves as trustee of a number of Miller family trusts.
F3Subject to adjustment for fractional shares.
F4At the election of the Issuer, the quarterly interest payment has been paid as paid-in-kind interest compounded to the original principal amount of the Note.
F5Includes all previously reported PIK Interest on Junior Secured Convertible Promissory Note.