0001628280-17-010291.txt : 20171026
0001628280-17-010291.hdr.sgml : 20171026
20171026211718
ACCESSION NUMBER: 0001628280-17-010291
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171026
FILED AS OF DATE: 20171026
DATE AS OF CHANGE: 20171026
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kalish Rami
CENTRAL INDEX KEY: 0001720208
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38253
FILM NUMBER: 171157698
MAIL ADDRESS:
STREET 1: C/O FORESCOUT TECHNOLOGIES INC
STREET 2: 190 WEST TASMAN DRIVE
CITY: SAN JOSE
STATE: CA
ZIP: 95134
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: FORESCOUT TECHNOLOGIES, INC
CENTRAL INDEX KEY: 0001145057
STANDARD INDUSTRIAL CLASSIFICATION: COMPUTER PERIPHERAL EQUIPMENT, NEC [3577]
IRS NUMBER: 510406800
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 900 E. HAMILTON AVE #300
CITY: CAMPBELL
STATE: CA
ZIP: 95008
BUSINESS PHONE: 866-377-8771
MAIL ADDRESS:
STREET 1: 900 E. HAMILTON AVE #300
CITY: CAMPBELL
STATE: CA
ZIP: 95008
FORMER COMPANY:
FORMER CONFORMED NAME: FORESCOUT TECHNOLOGIES INC
DATE OF NAME CHANGE: 20010717
3
1
wf-form3_150906702461971.xml
FORM 3
X0206
3
2017-10-26
0
0001145057
FORESCOUT TECHNOLOGIES, INC
FSCT
0001720208
Kalish Rami
11 HAMENOFIM STREET, BUILDING B
HERZELIYA
L3
46725
ISRAEL
1
0
1
0
Series F Convertible Preferred Stock
Common Stock
200927.0
I
See footnote
Series F Convertible Preferred Stock
Common Stock
18574.0
I
See footnote
Series F Convertible Preferred Stock
Common Stock
54330.0
I
See footnote
Series F Convertible Preferred Stock
Common Stock
7072.0
I
See footnote
Series F Convertible Preferred Stock
Common Stock
29235.0
I
See footnote
Series F Convertible Preferred Stock
Common Stock
14145.0
I
See footnote
The Series F Convertible Preferred Stock shall automatically convert into Common Stock on an approximate 1:1 basis immediately prior to the completion of the Issuer's initial public offering of common stock and has no expiration date.
The shares are held of record by Pitango Venture Capital Fund III (USA) L.P. ("Fund III USA"). Pitango V.C. Fund III General Partner ("Pitango GP"), the general partner of Fund III USA, has sole voting and dispositive power with respect to the shares held by Fund III USA. The reporting person shares voting and dispositive power with respect to the shares held by Pitango GP and disclaims beneficial ownership of the securities held by Fund III USA except to the extent of any pecuniary interest therein.
The shares are held of record by Pitango Venture Capital Fund III (USA) Non-Q L.P. ("Fund III USA Non-Q"). Pitango GP, the general partner of Fund III USA Non-Q, has sole voting and dispositive power with respect to the shares held by Fund III USA. The reporting person shares voting and dispositive power with respect to the shares held by Pitango GP and disclaims beneficial ownership of the securities held by Fund III USA except to the extent of any pecuniary interest therein.
The shares are held of record by Pitango Venture Capital Fund III (Israeli Investors) L.P. ("Fund III Israeli Investors"). Pitango GP, the general partner of Fund III Israeli Investors, has sole voting and dispositive power with respect to the shares held by Fund III Israeli Investors. The reporting person shares voting and dispositive power with respect to the shares held by Pitango GP and disclaims beneficial ownership of the securities held by Fund III USA except to the extent of any pecuniary interest therein.
The shares are held of record by Pitango Principals Fund III (USA) L.P. ("Principals Fund III"). Pitango GP, the general partner of Principals Fund III, has sole voting and dispositive power with respect to the shares held by Principals Fund III. The reporting person shares voting and dispositive power with respect to the shares held by Pitango GP and disclaims beneficial ownership of the securities held by Fund III USA except to the extent of any pecuniary interest therein.
The shares are held of record by Pitango Parallel Investor Fund III (USA) L.P ("Parallel Investor Fund"). Pitango GP, the general partner of Parallel Investor Fund, has sole voting and dispositive power with respect to the shares held by Parallel Investor Fund. The reporting person shares voting and dispositive power with respect to the shares held by Pitango GP and disclaims beneficial ownership of the securities held by Fund III USA except to the extent of any pecuniary interest therein.
The shares are held of record by Pitango Venture Capital Fund III Trusts 2000 Ltd ("Capital Fund 2000"). Capital Fund 2000 is owned and controlled indirectly by the Principals which holds shares of the Issuer in trust for three limited partnerships: Pitango CEO Fund III (USA) L.P., Pitango CEO Fund III (Israel) L.P. and Pitango Family Fund III (Israel) L.P. These three limited partnerships are managed by their sole general partner, the GP.
Pitango GP, the general partner of Parallel Investor Fund, has sole voting and dispositive power with respect to the shares held by Capital Fund 2000. The reporting person shares voting and dispositive power with respect to the shares held by Pitango GP and disclaims beneficial ownership of the securities held by Fund III USA except to the extent of any pecuniary interest therein.
This report on Form 3 is one of two reports relating to the same transaction.
/s/ Russell J. Wood, by power of attorney
2017-10-26