0001140361-17-038924.txt : 20171017 0001140361-17-038924.hdr.sgml : 20171017 20171017184608 ACCESSION NUMBER: 0001140361-17-038924 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171016 FILED AS OF DATE: 20171017 DATE AS OF CHANGE: 20171017 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ALLOY VENTURES 2002 LLC CENTRAL INDEX KEY: 0001176013 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38238 FILM NUMBER: 171141538 BUSINESS ADDRESS: STREET 1: 400 HAMILTON AVENUE STREET 2: 4TH FLOOR CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: 650-687-5000 MAIL ADDRESS: STREET 1: 400 HAMILTON AVENUE STREET 2: 4TH FLOOR CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ALLOY VENTURES 2005 LP CENTRAL INDEX KEY: 0001333202 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38238 FILM NUMBER: 171141534 BUSINESS ADDRESS: STREET 1: 400 HAMILTON AVENUE STREET 2: 4TH FLOOR CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: 6506875000 MAIL ADDRESS: STREET 1: 400 HAMILTON AVENUE STREET 2: 4TH FLOOR CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Alloy Ventures 2002, LP CENTRAL INDEX KEY: 0001356077 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38238 FILM NUMBER: 171141535 BUSINESS ADDRESS: STREET 1: 400 HAMILTON ST. STREET 2: 4TH FL. CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: 650-687-5000 MAIL ADDRESS: STREET 1: 400 HAMILTON ST. STREET 2: 4TH FL. CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Alloy Partners 2002, LP CENTRAL INDEX KEY: 0001356076 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38238 FILM NUMBER: 171141536 BUSINESS ADDRESS: STREET 1: 400 HAMILTON ST. STREET 2: 4TH FL. CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: 650-687-5000 MAIL ADDRESS: STREET 1: 400 HAMILTON ST. STREET 2: 4TH FL. CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Alloy Ventures 2005, LLC CENTRAL INDEX KEY: 0001355724 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38238 FILM NUMBER: 171141537 BUSINESS ADDRESS: STREET 1: 400 HAMILTON AVENUE, 4TH FLOOR CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: (650) 687-5000 MAIL ADDRESS: STREET 1: 400 HAMILTON AVENUE, 4TH FLOOR CITY: PALO ALTO STATE: CA ZIP: 94301 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Restoration Robotics Inc CENTRAL INDEX KEY: 0001409269 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 061681204 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 128 BAYTECH DRIVE CITY: SAN JOSE STATE: CA ZIP: 95134 BUSINESS PHONE: 408-883-6888 MAIL ADDRESS: STREET 1: 128 BAYTECH DRIVE CITY: SAN JOSE STATE: CA ZIP: 95134 4 1 doc1.xml FORM 4 X0306 4 2017-10-16 0 0001409269 Restoration Robotics Inc HAIR 0001176013 ALLOY VENTURES 2002 LLC 1415 HAMILTON AVE. PALO ALTO CA 94301 0 0 1 0 0001355724 Alloy Ventures 2005, LLC 1415 HAMILTON AVE. PALO ALTO CA 94301 0 0 1 0 0001356076 Alloy Partners 2002, LP 1415 HAMILTON AVE. PALO ALTO CA 94301 0 0 1 0 0001356077 Alloy Ventures 2002, LP 1415 HAMILTON AVE. PALO ALTO CA 94301 0 0 1 0 0001333202 ALLOY VENTURES 2005 LP 1415 HAMILTON AVE. PALO ALTO CA 94301 0 0 1 0 Common Stock 2017-10-16 4 C 0 12466 A 12466 I See Footnote Common Stock 2017-10-16 4 C 0 13650 A 26116 I See Footnote Common Stock 2017-10-16 4 C 0 16643 A 42759 I See Footnote Common Stock 2017-10-16 4 C 0 2282 7 A 45041 I See Footnote Common Stock 2017-10-16 4 C 0 461717 A 461717 I See Footnote Common Stock 2017-10-16 4 C 0 505580 A 967297 I See Footnote Common Stock 2017-10-16 4 C 0 616446 A 1583743 I See Footnote Common Stock 2017-10-16 4 C 0 84526 7 A 1668269 I See Footnote Common Stock 2017-10-16 4 C 0 474184 A 474184 I See Footnote Common Stock 2017-10-16 4 C 0 519230 A 993414 I See Footnote Common Stock 2017-10-16 4 C 0 633094 A 1626508 I See Footnote Common Stock 2017-10-16 4 C 0 86809 7 A 1713317 I See Footnote Series A Preferred Stock 2017-10-16 4 C 0 12466 D Common Stock 12466 0 I See Footnote Series A Preferred Stock 2017-10-16 4 C 0 461717 D Common Stock 461717 0 I See Footnote Series A Preferred Stock 2017-10-16 4 C 0 474184 D Common Stock 474184 0 I See Footnote Series B Preferred Stock 2017-10-16 4 C 0 13650 D Common Stock 13650 0 I See Footnote Series B Preferred Stock 2017-10-16 4 C 0 505580 D Common Stock 505580 0 I See Footnote Series B Preferred Stock 2017-10-16 4 C 0 519230 D Common Stock 519230 0 I See Footnote Series C Preferred Stock 2017-10-16 4 C 0 16643 D Common Stock 16643 0 I See Footnote Series C Preferred Stock 2017-10-16 4 C 0 616446 D Common Stock 616446 0 I See Footnote Series C Preferred Stock 2017-10-16 4 C 0 633094 D Common Stock 633094 0 I See Footnote Convertible Promissory Note 7 2017-10-16 4 C 0 15888.66 D Common Stock 2282 0 I See Footnote Convertible Promissory Note 7 2017-10-16 4 C 0 588463.1 D Common Stock 84526 0 I See Footnote Convertible Promissory Note 7 2017-10-16 4 C 0 604351.76 D Common Stock 86809 0 I See Footnote The shares of the Issuer's Preferred Stock automatically converted 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"). See additional Form 4 filed by Alloy Ventures 2002, LLC ("Ventures 2002") for additional members of this joint filing. The securities 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 securities 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 securities held by Alloy Partners 2002. Each Reporting Person disclaims beneficial ownership of such securities except to the extent of any pecuniary interest therein. See additional Form 4 filed by Ventures 2002 for additional members of this joint filing. The securities 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 securities 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 securities held by Alloy Ventures 2002. Each Reporting Person disclaims beneficial ownership of such securities except to the extent of any pecuniary interest therein. See additional Form 4 filed by Ventures 2002 for additional members of this joint filing. The securities 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 securities 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 securities held by Alloy Ventures 2005. Each Reporting Person disclaims beneficial ownership of such securities except to the extent of any pecuniary interest therein. The expiration date is not relevant to the conversion of these securities. The amount reported in column 5 is the principal amount of Reporting Person's Convertible Promissory Note (the "Note"). The outstanding principal and accrued interest of the Note automatically converted into shares of the Issuer's Common Stock at the price per share available to the public as set forth in the final prospectus related to the Issuer's IPO upon the closing of the IPO. /s/ Tony Di Bona, managing member of Alloy Ventures 2002, LLC 2017-10-16 /s/ Tony Di Bona, managing member of Alloy Ventures 2002, LLC, the general partner of Alloy Ventures 2002, L.P. 2017-10-16 /s/ Tony Di Bona, managing member of Alloy Ventures 2005, LLC 2017-10-16 /s/ Tony Di Bona, managing member of Alloy Ventures 2002, LLC, the general partner of Alloy Partners 2002, L.P. 2017-10-16 /s/ Tony Di Bona, managing member of Alloy Ventures 2005, LLC, the general partner of Alloy Ventures 2005, L.P. 2017-10-16