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