FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
EPOCRATES INC [ EPOC ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 02/07/2011 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 02/07/2011 | C | 836,107 | A | $0 | 836,107 | I | See Footnote(1) | ||
Common Stock | 02/07/2011 | C | 533,091 | A | $0 | 1,369,198 | I | See Footnote(1) | ||
Common Stock | 02/07/2011 | C | 449,819 | A | $0 | 1,819,017 | I | See Footnote(1) | ||
Common Stock | 02/07/2011 | C | 67,792 | A | $0 | 67,792 | I | See Footnote(2) | ||
Common Stock | 02/07/2011 | C | 43,223 | A | $0 | 111,015 | I | See Footnote(2) | ||
Common Stock | 02/07/2011 | C | 36,471 | A | $0 | 147,486 | I | See Footnote(2) | ||
Common Stock | 150,655 | I | See Footnote(3) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series A Convertible Preferred Stock | $0 | 02/07/2011 | C | 1,063,750 | (4) | (4) | Common Stock | 836,107 | $0 | 0 | I | See Footnote(1) | |||
Series A Convertible Preferred Stock | $0 | 02/07/2011 | C | 86,250 | (4) | (4) | Common Stock | 67,792 | $0 | 0 | I | See Footnote(2) | |||
Series B Convertible Preferred Stock | $0 | 02/07/2011 | C | 587,018 | (5) | (5) | Common Stock | 533,091 | $0 | 0 | I | See Footnote(1) | |||
Series B Convertible Preferred Stock | $0 | 02/07/2011 | C | 47,596 | (5) | (5) | Common Stock | 43,223 | $0 | 0 | I | See Footnote(2) | |||
Series C Convertible Preferred Stock | $0 | 02/07/2011 | C | 572,289 | (4) | (4) | Common Stock | 449,819 | $0 | 0 | I | See Footnote(1) | |||
Series C Convertible Preferred Stock | $0 | 02/07/2011 | C | 46,402 | (4) | (4) | Common Stock | 36,471 | $0 | 0 | I | See Footnote(2) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. The shares are owned by Draper Fisher Jurvetson Fund V, L.P. ("DFJ Fund V"). Draper Fisher Jurvetson Management Co. V, LLC is the general partner of DFJ Fund V and thereby has sole voting and investment control over the shares owned by DFJ Fund V. Timothy C. Draper, John H.N. Fisher and Stephen T. Jurvetson are the managing directors of Draper Fisher Jurvetson Management Co. V, LLC. They share voting and investment control over the shares owned DFJ Fund V. The managing directors disclaim beneficial ownership of the shares owned by DFJ Fund V except to the extent of their respective pecuniary interest therein. The general partner of DFJ Fund V disclaims beneficial ownership of the shares owned by DFJ Fund V except to the extent of its pecuniary interest therein. |
2. The shares are owned by Draper Fisher Jurvetson Partners V, LLC ("DFJ Partners V"). Timothy C. Draper, John H.N. Fisher and Stephen T. Jurvetson are the managing members of DFJ Partners V. They share voting and investment control over the shares owned by DFJ Partners V. The managing members disclaim beneficial ownership of the shares owned by the DFJ Partners V except to the extent of their respective pecuniary interest therein. |
3. The shares are held indirectly by Mr. Draper through the Timothy C. Draper 2010 Annuity Trust. |
4. Each of the shares of the Issuer's Series A Convertible Preferred Stock and Series C Convertible Preferred Stock automatically converted into 0.786 shares of the Issuer's Common Stock immediately prior to the closing of the Issuer's initial public offering and have no expiration date. |
5. Each of the shares of the Issuer's Series B Convertible Preferred Stock automatically converted into 0.90813437 shares of the Issuer's Common Stock immediately prior to the closing of the Issuer's initial public offering and has no expiration date. |
Draper Fisher Jurvetson Fund V, L.P., By: Draper Fisher Jurvetson Management Co. V, L.L.C., Its: General Partner, By: /s/ John Fisher, Managing Member | 02/07/2011 | |
Draper Fisher Jurvetson Management Co. V, L.L.C., By: /s/ John Fisher, Managing Member | 02/07/2011 | |
Draper Fisher Jurvetson Partners V, LLC, By: /s/ John Fisher, Managing Member | 02/07/2011 | |
/s/ Timothy C. Draper | 02/07/2011 | |
/s/ John H.N. Fisher | 02/07/2011 | |
/s/ Stephen T. Jurvetson | 02/07/2011 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |