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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 10/11/2017 |
3. Issuer Name and Ticker or Trading Symbol
Restoration Robotics Inc [ HAIR ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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) | |||||||
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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) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series C Preferred Stock | (1) | (1) | Common Stock | 14,818 | (1) | I | By Ltd Partnership (CHAT)(2) |
Series A Preferred Stock | (1) | (1) | Common Stock | 479,145 | (1) | I | By Ltd Partnership (SHV)(3) |
Series B Preferred Stock | (1) | (1) | Common Stock | 606,386 | (1) | I | By Ltd Partnership (SHV)(3) |
Series C Preferred Stock | (1) | (1) | Common Stock | 888,690 | (1) | I | By Ltd Partnership (SHV)(3) |
Series C Preferred Stock | (1) | (1) | Common Stock | 3,600 | (1) | I | By Profit Sharing Plan Trust(4) |
Series A Preferred Stock | (1) | (1) | Common Stock | 35,468 | (1) | I | By Trust(5) |
Series B Preferred Stock | (1) | (1) | Common Stock | 44,893 | (1) | I | By Trust(5) |
Series C Preferred Stock | (1) | (1) | Common Stock | 53,905 | (1) | I | By Trust(5) |
Explanation of Responses: |
1. The issuer's preferred stock will automatically convert into issuer's common stock on a one-to-one basis immediately prior to the closing of the issuer's initial public offering and has no expiration date. |
2. Shares held by a limited partnership of which the reporting person is a trustee of a trust which is the general partner. The reporting person disclaims beneficial ownership in these shares except as to the reporting person's pecuniary interest therein. |
3. Shares held by Sutter Hill Ventures, a California Limited Partnership. The reporting person is a managing director and member of the management committee of the general partner of Sutter Hill Ventures, a California Limited Partnership. The reporting person disclaims beneficial ownership in these shares except as to the reporting person's pecuniary interest therein. |
4. Shares held by the SHV Profit Sharing Plan, a retirement trust, for the benefit of the reporting person. |
5. Shares held by a trust of which the reporting person is a trustee. The reporting person disclaims beneficial ownership in these shares except as to the reporting person's pecuniary interest therein. |
Remarks: |
hairmls.txt |
/s/ Robert Yin, by power of attorney | 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. | ||
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. |