0001209191-17-039152.txt : 20170612 0001209191-17-039152.hdr.sgml : 20170612 20170612162012 ACCESSION NUMBER: 0001209191-17-039152 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170612 FILED AS OF DATE: 20170612 DATE AS OF CHANGE: 20170612 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: SHOTSPOTTER, INC CENTRAL INDEX KEY: 0001351636 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 7979 GATEWAY BLVD., STE. 210 CITY: NEWARK STATE: CA ZIP: 94560 BUSINESS PHONE: (510) 794-3100 MAIL ADDRESS: STREET 1: 7979 GATEWAY BLVD., STE. 210 CITY: NEWARK STATE: CA ZIP: 94560 FORMER COMPANY: FORMER CONFORMED NAME: SHOTSPOTTER INC DATE OF NAME CHANGE: 20110517 FORMER COMPANY: FORMER CONFORMED NAME: Shotspotter Inc DATE OF NAME CHANGE: 20060131 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Thomas T. Groos Revocable Trust CENTRAL INDEX KEY: 0001706008 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38107 FILM NUMBER: 17906513 BUSINESS ADDRESS: STREET 1: C/O SHOTSPOTTER, INC. STREET 2: 7979 GATEWAY BLVD., STE. 210 CITY: NEWARK STATE: CA ZIP: 94560 BUSINESS PHONE: (510) 794-3100 MAIL ADDRESS: STREET 1: C/O SHOTSPOTTER, INC. STREET 2: 7979 GATEWAY BLVD., STE. 210 CITY: NEWARK STATE: CA ZIP: 94560 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: RT Groos, LLC CENTRAL INDEX KEY: 0001706011 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38107 FILM NUMBER: 17906514 BUSINESS ADDRESS: STREET 1: C/O SHOTSPOTTER, INC. STREET 2: 7979 GATEWAY BLVD., STE. 210 CITY: NEWARK STATE: CA ZIP: 94560 BUSINESS PHONE: (510) 794-3100 MAIL ADDRESS: STREET 1: C/O SHOTSPOTTER, INC. STREET 2: 7979 GATEWAY BLVD., STE. 210 CITY: NEWARK STATE: CA ZIP: 94560 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Groos Thomas T. CENTRAL INDEX KEY: 0001706000 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38107 FILM NUMBER: 17906515 MAIL ADDRESS: STREET 1: C/O SHOTSPOTTER, INC. STREET 2: 7979 GATEWAY BLVD., STE. 210 CITY: NEWARK STATE: CA ZIP: 94560 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-06-12 0 0001351636 SHOTSPOTTER, INC SSTI 0001706000 Groos Thomas T. IONIA ST. SW, STE. 505 GRAND RAPIDS MI 49503 1 0 1 0 0001706011 RT Groos, LLC IONIA ST. SW, STE. 505 GRAND RAPIDS MI 49503 0 0 1 0 0001706008 Thomas T. Groos Revocable Trust IONIA ST. SW, STE. 505 GRAND RAPIDS MI 49503 0 0 1 0 Common Stock 2017-06-12 4 C 0 855 0.00 A 1984 D Common Stock 2017-06-12 4 C 0 845 0.00 A 845 I By Trust Common Stock 2017-06-12 4 C 0 61670 0.00 A 62515 I By Trust Common Stock 2017-06-12 4 C 0 62857 0.00 A 190648 I By Limited Liability Company Common Stock 2017-06-12 4 C 0 327728 0.00 A 518376 I By Limited Liability Company Series A-2 Preferred Stock 2017-06-12 4 C 0 1129 D Common Stock 855 0 D Series A-2 Preferred Stock 2017-06-12 4 C 0 1182 D Common Stock 845 0 I By Trust Series B-1 Preferred Stock 2017-06-12 4 C 0 61670 D Common Stock 61670 0 I By Trust Series A-2 Preferred Stock 2017-06-12 4 C 0 87845 D Common Stock 62857 0 I By Limited Liability Company Series B-1 Preferred Stock 2017-06-12 4 C 0 327728 D Common Stock 327728 0 I By Limited Liability Company Warrant (Right to Buy) 2017-06-12 4 C 0 11703 A 2021-02-13 Common Stock 11703 11703 I By Trust Warrant (Right to Buy) 2017-06-12 4 C 0 39012 A 2021-02-13 Common Stock 39012 39012 I By Limited Liability Company Warrant (Right to Buy) 2017-06-12 4 C 0 2270 A 2019-07-12 Common Stock 2270 2270 I By Trust Warrant (Right to Buy) 2017-06-12 4 C 0 869 A 2019-07-12 Common Stock 869 869 I By Limited Liability Company Shares held directly by The Thomas T. Groos Revocable Trust, over which Thomas T. Groos holds voting and dispositive power. Shares held directly by RT Groos, LLC, over which Thomas T. Groos holds voting and dispositive power. Each share of Series A-2 Preferred Stock automatically converted into 0.715548 shares of Common Stock upon the closing of the Issuer's initial public offering of Common Stock and has no expiration date. Inapplicable. Each share of Series B-1 Preferred Stock automatically converted into 1 share of Common Stock upon the closing of the Issuer's initial public offering of Common Stock and has no expiration date. Right has converted from right to buy Series B-1 Preferred Stock to right to buy Common Stock. Immediate. /s/ Thomas T. Groos 2017-06-12 /s/ Thomas T. Groos, Member 2017-06-12 /s/ Thomas T. Groos, Trustee 2017-06-12