0001209191-16-145895.txt : 20161014 0001209191-16-145895.hdr.sgml : 20161014 20161014143450 ACCESSION NUMBER: 0001209191-16-145895 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161012 FILED AS OF DATE: 20161014 DATE AS OF CHANGE: 20161014 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Coupa Software Inc CENTRAL INDEX KEY: 0001385867 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 204429448 STATE OF INCORPORATION: DE BUSINESS ADDRESS: STREET 1: 1855 S. GRANT STREET CITY: SAN MATEO STATE: CA ZIP: 94402 BUSINESS PHONE: 6509313200 MAIL ADDRESS: STREET 1: 1855 S. GRANT STREET CITY: SAN MATEO STATE: CA ZIP: 94402 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ericson William W. CENTRAL INDEX KEY: 0001503381 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37901 FILM NUMBER: 161936802 MAIL ADDRESS: STREET 1: 777 MARINERS ISLAND BOULEVARD STREET 2: SUITE 550 CITY: SAN MATEO STATE: CA ZIP: 94404 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FEIBER JONATHAN D CENTRAL INDEX KEY: 0001027621 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37901 FILM NUMBER: 161936803 MAIL ADDRESS: STREET 1: 3000 SAND HILL ROAD BLDG 1 CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ninth MDV Partners, L.L.C. CENTRAL INDEX KEY: 0001573991 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37901 FILM NUMBER: 161936804 BUSINESS ADDRESS: STREET 1: 777 MARINERS ISLAND BOULEVARD STREET 2: SUITE 550 CITY: SAN MATEO STATE: CA ZIP: 94404 BUSINESS PHONE: 650-234-4840 MAIL ADDRESS: STREET 1: 777 MARINERS ISLAND BOULEVARD STREET 2: SUITE 550 CITY: SAN MATEO STATE: CA ZIP: 94404 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MDV IX LP CENTRAL INDEX KEY: 0001410787 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37901 FILM NUMBER: 161936805 BUSINESS ADDRESS: STREET 1: 777 MARINERS ISLAND BOULEVARD STREET 2: SUITE 550 CITY: SAN MATEO STATE: CA ZIP: 94404 BUSINESS PHONE: 650-234-4840 MAIL ADDRESS: STREET 1: 777 MARINERS ISLAND BOULEVARD STREET 2: SUITE 550 CITY: SAN MATEO STATE: CA ZIP: 94404 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-10-12 0 0001385867 Coupa Software Inc COUP 0001410787 MDV IX LP 777 MARINERS ISLAND BLVD. SUITE 550 SAN MATEO CA 94404 0 0 1 0 0001573991 Ninth MDV Partners, L.L.C. 777 MARINERS ISLAND BLVD. SUITE 550 SAN MATEO CA 94404 0 0 1 0 0001027621 FEIBER JONATHAN D 777 MARINERS ISLAND BLVD. SUITE 550 SAN MATEO CA 94404 0 0 1 0 0001503381 Ericson William W. 777 MARINERS ISLAND BLVD. SUITE 550 SAN MATEO CA 94404 0 0 1 0 Common Stock 2016-10-12 4 C 0 6648700 A 6648700 I MDV IX, L.P., as nominee for MDV IX, L.P., and MDV ENF IX, L.P. Series D Convertible Preferred Stock 1.3524 2016-10-12 4 C 0 5546449 D Common Stock 5546449 0 I MDV IX, L.P., as nominee for MDV IX, L.P., and MDV ENF IX, L.P. Series E Convertible Preferred Stock 3.1148 2016-10-12 4 C 0 1015725 D Common Stock 1015725 0 I MDV IX, L.P., as nominee for MDV IX, L.P., and MDV ENF IX, L.P. Series F Convertible Preferred Stock 8.09 2016-10-12 4 C 0 86526 D Common Stock 86526 0 I MDV IX, L.P., as nominee for MDV IX, L.P., and MDV ENF IX, L.P. Each 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. Ninth 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. /s/ Brett Teele 2016-10-14