SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
FRIEND DAVID

(Last) (First) (Middle)
C/O CARBONITE, INC.
177 HUNTINGTON AVENUE

(Street)
BOSTON MA 02115

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/10/2011
3. Issuer Name and Ticker or Trading Symbol
Carbonite Inc [ CARB ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
CEO and President
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 669,383 D
Common Stock 3,000 I(1) By Son(1)
Common Stock 3,000 I(2) By Son(2)
Common Stock 3,000 I(3) By Daughter(3)
Common Stock 3,000 I(4) By Daughter(4)
Common Stock 100,000 I(5) By Trust(5)
Common Stock 500,000 I(6) By Trust(6)
Common Stock 101,849 I(7) By Trust(7)
Common Stock 106,806 I(8) By Trust(8)
Common Stock 101,849 I(9) By Trust(9)
Common Stock 106,806 I(10) By Trust(10)
Common Stock 24,000 I(11) By Trust(11)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (right to buy) (12) 10/02/2018 Common Stock 134,661 $1.31 D
Stock Option (right to buy) (13) 11/14/2019 Common Stock 24,376 $2.64 D
Stock Option (right to buy) (14) 11/14/2019 Common Stock 18,375 $2.64 D
Series A Preferred Stock (15) (15) Common Stock 68,493(16) (15) D
Series A-2 Preferred Stock (15) (15) Common Stock 16,782(16) (15) D
Explanation of Responses:
1. These shares are owned by Jasper Friend. The reporting person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
2. These shares are owned by Zachery Friend. The reporting person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
3. These shares are owned by Lilian Friend. The reporting person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
4. These shares are owned by Zoe Friend. The reporting person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
5. These shares are owned by the David Friend 2011 Qualified Annunity Trust I. The reporting person is trustee of the trust. The reporting person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
6. These shares are owned by the David Friend 2010 Qualified Annunity Trust I. The reporting person is trustee of the trust. The reporting person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
7. These shares are owned by the David Friend 2009 Qualified Annunity Trust II. The reporting person is trustee of the trust. The reporting person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
8. These shares are owned by the David Friend 2009 Qualified Annunity Trust III. The reporting person is trustee of the trust. The reporting person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
9. These shares are owned by the Margaret F.A. Shepherd 2009 Qualified Annuity Trust. The reporting person's spouse is trustee of the trust. The reporting person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
10. These shares are owned by the Margaret F.A. Shepherd 2009 Qualified Annuity Trust II. The reporting person's spouse is trustee of the trust. The reporting person disclaims beneficial ownership of these securities and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
11. These shares are owned by the Friend-Shepherd Family 2009 Irrevocable Trust. The reporting person is trustee of the trust. The reporting person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
12. This option is currently exerciseable as to 26,931 shares of common stock and becomes exerciseable as to the remaining underlying shares of common stock in 4 equal quarterly installments beginning on November 7, 2011.
13. This option becomes exerciseable in 10 equal quarterly installments beginning on August 14, 2011.
14. This option becomes exerciseable in 14 equal quarterly installments beginning on August 14, 2011.
15. The Issuer's Preferred Stock will convert into Common Stock on a 1:3 basis upon the closing of the Issuer's initial public offering and has no expiration date.
16. Reflects the conversion of the Issuer's Preferred Stock into Common Stock on a 1:3 basis.
Remarks:
/s/ Danielle Sheer, by power of attorney 08/10/2011
** 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 5 (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.
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