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