SEC Form 4 · accession 0001140361-15-019188

CapForce Inc. · CFOR

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

Reporting owner

Director

Period of report

May 8, 2015

Accepted (ET)

May 12, 2015 · 6:44 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001293818

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F2	May 8, 2015	P	12,500	$6.00	A	68,317	I	See footnote
Common Stock^F1,F2	May 8, 2015	C	320,011	—	A	388,328	I	See footnote

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Series A Redeemable Convertible Preferred Stock^F2,F1	—	May 8, 2015	C	320,011	D	—	—	Common Stock	320,011	0	I
Warrants^F2	$6.60	May 8, 2015	P	12,500	A	May 8, 2015	May 8, 2020	Common Stock	12,500	0	I

F1Series A Redeemable Convertible Preferred Stock automatically converted into common stock on a 1-to-1 basis upon the consummation of the Company's initial public offering.
F2The securities are directly held by CHL Medical Partners III, L.P. and CHL Medical Partners III Side Fund, L.P. (collectively, the "CHL Medical Partners Funds"). Mr. Howe is an officer of the General Partner of CHL Medical Partners Funds, and may be deemed to have shared voting and dispositive power over the shares owned by CHL Medical Partners Funds. Mr. Howe disclaims beneficial ownership of all shares held by CHL Medical Partners Funds, except to the extent of his actual pecuniary interest therein.