SEC Form 4 · accession 0001209191-15-080857

INSTRUCTURE INC · INST

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

Reporting owner

Director · 10% Owner

Period of report

Nov 18, 2015

Accepted (ET)

Nov 18, 2015 · 2:08 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	Nov 18, 2015	C	319,306	$0.00	A	572,806	I	By Epic Expansion Capital Annex, LLC
Common Stock^{F1,F3,F4,F5,F2}	Nov 18, 2015	C	2,578,199	$0.00	A	2,672,811	I	By Epic Venture Fund IV, LLC
Common Stock^{F1,F3,F4,F5,F2}	Nov 18, 2015	C	1,168,549	$0.00	A	1,204,460	I	By Zions SBIC LLC
Common Stock^F6,F2	Nov 18, 2015	C	374,999	$0.00	A	374,999	I	By Epic Expansion Capital, LLC
Common Stock^F7	holding	—	—		—	39,149	I	By NKE Investments LLC

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Series A Preferred Stock^F1,F2,F8	—	Nov 18, 2015	C	319,306	D	—	—	Common Stock	319,306	I
Series A Preferred Stock^F1,F2,F8	—	Nov 18, 2015	C	1,352,194	D	—	—	Common Stock	1,352,194	I
Series A Preferred Stock^F1,F2,F8	—	Nov 18, 2015	C	26,623	D	—	—	Common Stock	26,623	I
Series B Preferred Stock^F3,F2,F8	—	Nov 18, 2015	C	784,314	D	—	—	Common Stock	784,314	I
Series B Preferred Stock^F3,F2,F8	—	Nov 18, 2015	C	784,313	D	—	—	Common Stock	784,313	I
Series C Preferred Stock^F4,F2,F8	—	Nov 18, 2015	C	378,799	D	—	—	Common Stock	378,799	I
Series C Preferred Stock^F4,F2,F8	—	Nov 18, 2015	C	143,777	D	—	—	Common Stock	143,777	I
Series D Preferred Stock^F5,F2,F8	—	Nov 18, 2015	C	62,892	D	—	—	Common Stock	62,892	I
Series D Preferred Stock^F5,F2,F8	—	Nov 18, 2015	C	213,836	D	—	—	Common Stock	213,836	I
Series E Preferred Stock^F6,F2,F8	—	Nov 18, 2015	C	273,710	D	—	—	Common Stock	374,999	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.
F2Mr. Efstratis has shared voting and investment power with respect to the shares held by Epic Expansion Capital Annex, LLC, Epic Expansion Capital, LLC, Epic Venture Fund IV, LLC and Zions SBIC LLC. Mr. Efstratis disclaims beneficial ownership of the securities held by such entities, except to the extent of any pecuniary interest therein.
F3The Series B Preferred Stock automatically converted into Common Stock of the Issuer on a 1-to-1 basis upon closing of the initial public offering of the Issuer.
F4The Series C Preferred Stock automatically converted into Common Stock of the Issuer on a 1-to-1 basis upon closing of the initial public offering of the Issuer.
F5The Series D Preferred Stock automatically converted into Common Stock of the Issuer on a 1-to-1 basis upon closing of the initial public offering of the Issuer.
F6The Series E Preferred Stock automatically converted into Common Stock of the Issuer on a 1-to-1.3700625 basis upon closing of the initial public offering of the Issuer.
F7Mr. Efstratis has voting and dispositive power over the shares held by NKE Investments, LLC.
F8Not applicable.