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*
PICKERING ROBERT

(Last) (First) (Middle)
621 PINEY PT.

(Street)
HOUSTON TX 77027

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
03/12/2002
3. Issuer Name and Ticker or Trading Symbol
PERFICIENT INC [ PRFT ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
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)
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
Series A Preferred Stock (1) (1) Common Stock 100,000 $1(2) I Watershed Perficient, LLC(3)
Warrant 01/07/2002 12/30/2011 Common stock 50,000 $2 I Watershed Perficient, LLC(4)
Explanation of Responses:
1. Represents shares of common stock into which the Series A Preferred Stock is convertible.
2. Each share of Series A Preferred Stock was initially convertible into one share of common stock.
3. The 100,000 shares of Series A Preferred Stock represents Mr. Pickering's proportionate interest in the 625,000 shares of Series A Preferred Stock held by Watershed Perficient, LLC, of which Mr. Pickering is a member.
4. The 50,000 warrants to purchase Common Stock represents Mr. Pickering's proportionate interest in the 312,500 warrants held by Watershed Perficient, LLC, of which Mr. Pickering is a member.
Robert Pickering, Jr. 11/21/2003
** 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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