SEC Form 4 · accession 0001209191-16-145895

Coupa Software Inc · COUP

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

Reporting owners

10% Owner

10% Owner

10% Owner

10% Owner

Period of report

Oct 12, 2016

Accepted (ET)

Oct 14, 2016 · 2:34 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001385867

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F2	Oct 12, 2016	C	6,648,700	—	A	6,648,700	I	MDV IX, L.P., as nominee for MDV IX, L.P., and MDV ENF IX, L.P.

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Series D Convertible Preferred Stock^F1,F2	$1.3524	Oct 12, 2016	C	5,546,449	D	—	—	Common Stock	5,546,449	I
Series E Convertible Preferred Stock^F1,F2	$3.1148	Oct 12, 2016	C	1,015,725	D	—	—	Common Stock	1,015,725	I
Series F Convertible Preferred Stock^F1,F2	$8.09	Oct 12, 2016	C	86,526	D	—	—	Common Stock	86,526	I

F1Each share of Series D Convertible Preferred Stock, Series E Convertible Preferred Stock and Series F Convertible Preferred Stock automatically converted into one share of Issuer's Common Stock for no additional consideration immediately prior to the completion of the Issuer's initial public offering. The exercisability date and expiration date are not relevant to the conversion of these securities.
F2Ninth MDV Partners, L.L.C. is the general partner of MDV IX, L.P., as nominee for MDV IX, L.P. and MDV ENF IX, L.P. (collectively, "MDV IX"). William Ericson ("Ericson") and Jonathan Feiber ("Feiber") are Managing Members of Ninth MDV Partners, L.L.C. Ericson and Feiber may be deemed to share voting and dispositive power over the shares held by MDV IX and disclaim beneficial ownership of the shares held by MDV IX except to the extent of their pecuniary interest therein.