FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
FAVRILLE INC [ FVRL ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 03/07/2006 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 03/07/2006 | P(1) | 1,425,856 | A | $5.26 | 4,258,380 | D(2)(3) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Stock Warrants (right to buy) | $5.26 | 03/07/2006 | P | 499,049 | (4) | 03/07/2011 | Common Stock | 499,049 | $0.125 | 499,049 | D(5) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. This report constitutes one of two reports filed on behalf of the Alloy entities reporting one transaction. |
2. The shares are held of record as follows: 203,046 shares by Alloy Corporate 2000, L.P. ("Corporate"), 86,590 shares by Alloy Partners 2000, L.P. ("Partners"), 1,689,486 shares by Alloy Ventures 2000, L.P. ("Ventures"), 348,350 shares by Alloy Investors 2000, L.P. ("Investors"); 505,052 shares by Alloy Annex I, L.P. ("Annex"); and 1,425,856 shares by Alloy Ventures 2005, L.P. |
3. Alloy Ventures 2000, LLC ("Ventures LLC"), is the general partner of Corporate, Partners, Ventures and Investors. Alloy Annex I, LLC ("Annex LLC") is the general partner of Annex, and Alloy Ventures 2005, LLC ("Ventures 2005 LLC") is the general partner of Alloy Ventures 2005, L.P. Craig C. Taylor, John F. Shoch, Douglas E. Kelly, M.D., J. Leighton Read, M.D. and Tony Di Bona are managing members of each of Ventures LLC, Annex LLC and Ventures 2005 LLC, and may be deemed to have shared power to vote all of these shares. Daniel I. Rubin is a managing member of Annex LLC and Ventures 2005 LLC, and Ammar H. Hanafi and Michael W. Hunkapiller are managing members of Ventures 2005, LLC, and may be deemed to have shared power to vote all of the shares controlled by these entities. |
4. Immediately. |
5. The warrants are held of record by Alloy Ventures 2005, L.P. |
/s/ Douglas E. Kelly | 03/09/2006 | |
** 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 4 (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. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |