SEC FORM 3

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^*

ALLOY VENTURES 2002 LLC

(Last)

(First)

(Middle)

1415 HAMILTON AVENUE

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
10/11/2017

3. Issuer Name and Ticker or Trading Symbol
Restoration Robotics Inc [ HAIR ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

Director	X	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)

	Form filed by One Reporting Person
X	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)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	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)
Series A Preferred Stock	⁽¹⁾	⁽²⁾	Common Stock	12,466	⁽¹⁾	I	See Footnote⁽³⁾
Series A Preferred Stock	⁽¹⁾	⁽²⁾	Common Stock	461,717	⁽¹⁾	I	See Footnote⁽⁴⁾
Series A Preferred Stock	⁽¹⁾	⁽²⁾	Common Stock	474,184	⁽¹⁾	I	See Footnote⁽⁵⁾
Series B Preferred Stock	⁽¹⁾	⁽²⁾	Common Stock	13,650	⁽¹⁾	I	See Footnote⁽³⁾
Series B Preferred Stock	⁽¹⁾	⁽²⁾	Common Stock	505,580	⁽¹⁾	I	See Footnote⁽⁴⁾
Series B Preferred Stock	⁽¹⁾	⁽²⁾	Common Stock	519,230	⁽¹⁾	I	See Footnote⁽⁵⁾
Series C Preferred Stock	⁽¹⁾	⁽²⁾	Common Stock	16,643	⁽¹⁾	I	See Footnote⁽³⁾
Series C Preferred Stock	⁽¹⁾	⁽²⁾	Common Stock	616,446	⁽¹⁾	I	See Footnote⁽⁴⁾
Series C Preferred Stock	⁽¹⁾	⁽²⁾	Common Stock	633,094	⁽¹⁾	I	See Footnote⁽⁵⁾

1. Name and Address of Reporting Person^*

ALLOY VENTURES 2002 LLC

(Last)

(First)

(Middle)

1415 HAMILTON AVENUE

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

Relationship of Reporting Person(s) to Issuer

Director	X	10% Owner
Officer (give title below)		Other (specify below)

1. Name and Address of Reporting Person^*

KELLY DOUGLAS E

(Last)

(First)

(Middle)

400 HAMILTON AVENUE 4TH FLOOR

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

Relationship of Reporting Person(s) to Issuer

Director	X	10% Owner
Officer (give title below)		Other (specify below)

1. Name and Address of Reporting Person^*

Shoch John

(Last)

(First)

(Middle)

400 HAMILTON AVENUE 4TH FLOOR

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

Relationship of Reporting Person(s) to Issuer

Director	X	10% Owner
Officer (give title below)		Other (specify below)

1. Name and Address of Reporting Person^*

Di Bona Tony

(Last)

(First)

(Middle)

400 HAMILTON AVENUE 4TH FLOOR

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

Relationship of Reporting Person(s) to Issuer

Director	X	10% Owner
Officer (give title below)		Other (specify below)

1. Name and Address of Reporting Person^*

Rubin Daniel

(Last)

(First)

(Middle)

400 HAMILTON AVENUE 4TH FLOOR

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

Relationship of Reporting Person(s) to Issuer

Director	X	10% Owner
Officer (give title below)		Other (specify below)

1. Name and Address of Reporting Person^*

Hunkapiller Michael

(Last)

(First)

(Middle)

400 HAMILTON AVENUE 4TH FLOOR

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

Relationship of Reporting Person(s) to Issuer

Director	X	10% Owner
Officer (give title below)		Other (specify below)

1. Name and Address of Reporting Person^*

Hanafi Ammar

(Last)

(First)

(Middle)

400 HAMILTON AVENUE 4TH FLOOR

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

Relationship of Reporting Person(s) to Issuer

Director	X	10% Owner
Officer (give title below)		Other (specify below)

Explanation of Responses:

1. The shares of the Issuer's Preferred Stock automatically convert into shares of the Issuer's Common Stock, for no additional consideration, on a 1:1 basis immediately prior to the consummation of the Issuer's Initial Public Offering (the "IPO").

2. The expiration date is not relevant to the conversion of these securities.

3. See additional Form 4 filed by Alloy Ventures 2002, LLC ("Ventures 2002") for additional members of this joint filing. The shares are directly held by Alloy Partners 2002, L.P. ("Alloy Partners 2002"). Ventures 2002, as the sole general partner of Alloy Partners 2002, may be deemed to beneficially own the shares held by Alloy Partners 2002. Craig Taylor, Douglas Kelly, John Shoch, Tony DiBona and Daniel Rubin are managing directors of Ventures 2002, and as such may be deemed to beneficially own the shares held by Alloy Partners 2002. Each Reporting Person disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein.

4. See additional Form 4 filed by Ventures 2002 for additional members of this joint filing. The shares are directly held by Alloy Ventures 2002, L.P. ("Alloy Ventures 2002"). Ventures 2002, as the sole general partner of Alloy Ventures 2002, may be deemed to beneficially own the shares held by Alloy Ventures 2002. Craig Taylor, Douglas Kelly, John Shoch, Tony DiBona and Daniel Rubin are managing directors of Ventures 2002, and as such may be deemed to beneficially own the shares held by Alloy Ventures 2002. Each Reporting Person disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein.

5. See additional Form 4 filed by Ventures 2002 for additional members of this joint filing. The shares are directly held by Alloy Ventures 2005, L.P. ("Alloy Ventures 2005"). Alloy Ventures 2005, LLC ("Ventures 2005"), as the sole general partner of Alloy Ventures 2005, may be deemed to beneficially own the shares held by Alloy Ventures 2005. Craig Taylor, Douglas Kelly, John Shoch, Tony DiBona, Daniel Rubin, Michael Hunkapiller and Ammar H. Hanafi are managing directors of Ventures 2005, and as such may be deemed to beneficially own the shares held by Alloy Ventures 2005. Each Reporting Person disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein.

	/s/ Tony Di Bona, managing member of Alloy Ventures 2002, LLC	10/11/2017
	/s/ Tony Di Bona, attorney-in-fact for Douglas E. Kelly	10/11/2017
	/s/ Tony Di Bona, attorney-in-fact for John F. Shoch	10/11/2017
	/s/ Tony Di Bona, attorney-in-fact for Daniel I. Rubin	10/11/2017
	/s/ Tony Di Bona, attorney-in-fact for Michael W. Hunkapiller	10/11/2017
	/s/ Tony Di Bona, attorney-in-fact for Ammar H. Hanafi	10/11/2017
	/s/ Tony Di Bona	10/11/2017
	** 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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