SEC Form 4 · accession 0001209191-15-080847

INSTRUCTURE INC · INST

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

Reporting owner

Officer — Chief Executive Officer · Director · 10% Owner

Period of report

Nov 18, 2015

Accepted (ET)

Nov 18, 2015 · 1:55 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001355754

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F2,F3	Nov 18, 2015	C	781,141	$0.00	A	2,664,474	I	By Grizzly Peak, LLC
Common Stock^F4	Nov 18, 2015	P	81,250	$16.00	A	81,250	I	By The Joshua and CeliAnne Coates Trust
Common Stock^F5	Nov 18, 2015	P	43,750	$16.00	A	43,750	I	By The Coates Equity Trust

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Series A Preferred Stock^F1,F3,F6	—	Nov 18, 2015	C	256,383	D	—	—	Common Stock	256,383	0	I
Series B Preferred Stock^F2,F3,F6	—	Nov 18, 2015	C	524,758	D	—	—	Common Stock	524,758	0	I

F1The Series A Preferred Stock automatically converted into Common Stock on a 1-to-1 basis upon closing of the initial public offering of the Issuer.
F2The Series B Preferred Stock automatically converted into Common Stock on a 1-to-1 basis upon closing of the initial public offering of the Issuer.
F3Mr. Coates is the manager of Grizzly Peak, LLC and has sole voting and investment power with respect to the shares held by Grizzly Peak, LLC.
F4Mr. Coates and his wife are the trustees and beneficiaries of The Joshua and CeliAnne Coates Trust and have sole voting and investment power with respect to the shares held by The Joshua and CeliAnne Coates Trust.
F5Mr. Coates and his wife are the trustees and beneficiaries of The Coates Equity Trust and have sole voting and investment power with respect to the shares held by The Coates Equity Trust.
F6Not applicable.