0001209191-16-142323.txt : 20160921
0001209191-16-142323.hdr.sgml : 20160921
20160921181159
ACCESSION NUMBER: 0001209191-16-142323
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160921
FILED AS OF DATE: 20160921
DATE AS OF CHANGE: 20160921
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: EVERBRIDGE, INC.
CENTRAL INDEX KEY: 0001437352
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 25 CORPORATE DRIVE
STREET 2: SUITE 400
CITY: BURLINGTON
STATE: MA
ZIP: 01803
BUSINESS PHONE: 818-230-9700
MAIL ADDRESS:
STREET 1: 25 CORPORATE DRIVE
STREET 2: SUITE 400
CITY: BURLINGTON
STATE: MA
ZIP: 01803
FORMER COMPANY:
FORMER CONFORMED NAME: 3N GLOBAL INC
DATE OF NAME CHANGE: 20080611
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: PUTRA CINTAWATI W.
CENTRAL INDEX KEY: 0001684552
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37874
FILM NUMBER: 161896403
MAIL ADDRESS:
STREET 1: C/O EVERBRIDGE, INC.
STREET 2: 25 CORPORATE DRIVE, SUITE 400
CITY: BURLINGTON
STATE: MA
ZIP: 01803
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2016-09-21
0
0001437352
EVERBRIDGE, INC.
EVBG
0001684552
PUTRA CINTAWATI W.
C/O EVERBRIDGE, INC.
25 CORPORATE DRIVE, SUITE 400
BURLINGTON
MA
01803
1
0
0
0
Common Stock
2016-09-21
4
C
0
171974
A
1131628
I
See Footnote
Common Stock
2016-09-21
4
S
0
190211
11.16
D
941417
I
See Footnote
Common Stock
23179
D
Common Stock
521739
I
See Footnote
Common Stock
521739
I
See Footnote
Common Stock
1304
I
By spouse
Series A-1 Preferred Stock
2016-09-21
4
C
0
171974
D
Common Stock
171974
0
I
See Footnote
The Series A-1 Preferred Stock, which had no expiration date, automatically converted to common stock on a 1-for-1 basis upon the completion of the Issuer's initial public offering.
The shares are held by the Steven T. Kirchmeier and Cintawati W. Putra Living Trust Dated May 5, 2015, of which the reporting person and her spouse are trustee.
The shares were sold in the Issuer's initial public offering, pursuant to a Form S-1 Registration Statement which was declared effective on September 15, 2016. The reported sale price reflects the price at which the shares were sold to the underwriters.
The shares are held by the Cintawati W. Putra 2015 Grantor Retained Annuity Trust, of which the reporting person and her spouse are trustee.
The shares are held by the Steven T. Kirchmeier 2015 Grantor Retained Annuity Trust, of which the reporting person and her spouse are trustee.
/s/ Richard Segal, Attorney-in-Fact
2016-09-21