0001628280-21-022627.txt : 20211109
0001628280-21-022627.hdr.sgml : 20211109
20211109184512
ACCESSION NUMBER: 0001628280-21-022627
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211109
FILED AS OF DATE: 20211109
DATE AS OF CHANGE: 20211109
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Unameit Trust under Declaration of Trust dated March 10, 2000
CENTRAL INDEX KEY: 0001892240
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41043
FILM NUMBER: 211393696
BUSINESS ADDRESS:
STREET 1: THREE LAGOON DRIVE
STREET 2: SUITE 400
CITY: REDWOOD CITY
STATE: CA
ZIP: 94065
BUSINESS PHONE: (650) 365-4646
MAIL ADDRESS:
STREET 1: THREE LAGOON DRIVE
STREET 2: SUITE 400
CITY: REDWOOD CITY
STATE: CA
ZIP: 94065
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: DeMartini James G B III
CENTRAL INDEX KEY: 0001892193
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41043
FILM NUMBER: 211393697
MAIL ADDRESS:
STREET 1: THREE LAGOON DRIVE
STREET 2: SUITE 400
CITY: REDWOOD CITY
STATE: CA
ZIP: 94065
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: FBHR Associates LLC
CENTRAL INDEX KEY: 0001892268
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41043
FILM NUMBER: 211393699
BUSINESS ADDRESS:
STREET 1: THREE LAGOON DRIVE
STREET 2: SUITE 400
CITY: REDWOOD CITY
STATE: CA
ZIP: 94065
BUSINESS PHONE: (650) 365-4646
MAIL ADDRESS:
STREET 1: THREE LAGOON DRIVE
STREET 2: SUITE 400
CITY: REDWOOD CITY
STATE: CA
ZIP: 94065
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Hillsven LLC
CENTRAL INDEX KEY: 0001892243
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41043
FILM NUMBER: 211393698
BUSINESS ADDRESS:
STREET 1: THREE LAGOON DRIVE
STREET 2: SUITE 400
CITY: REDWOOD CITY
STATE: CA
ZIP: 94065
BUSINESS PHONE: (650) 365-4646
MAIL ADDRESS:
STREET 1: THREE LAGOON DRIVE
STREET 2: SUITE 400
CITY: REDWOOD CITY
STATE: CA
ZIP: 94065
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Expensify, Inc.
CENTRAL INDEX KEY: 0001476840
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 270239450
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 401 SW 5TH AVENUE
CITY: PORTLAND
STATE: OR
ZIP: 97204
BUSINESS PHONE: (520) 271-0858
MAIL ADDRESS:
STREET 1: 401 SW 5TH AVENUE
CITY: PORTLAND
STATE: OR
ZIP: 97204
3
1
wf-form3_163650149571697.xml
FORM 3
X0206
3
2021-11-09
0
0001476840
Expensify, Inc.
[EXFY]
0001892243
Hillsven LLC
THREE LAGOON DR., SUITE 400
REDWOOD CITY
CA
94065
0
0
1
0
0001892268
FBHR Associates LLC
THREE LAGOON DR., SUITE 400
REDWOOD CITY
CA
94065
0
0
1
0
0001892193
DeMartini James G B III
THREE LAGOON DR., SUITE 400
REDWOOD CITY
CA
94065
0
0
1
0
0001892240
Unameit Trust under Declaration of Trust dated March 10, 2000
THREE LAGOON DR., SUITE 400
REDWOOD CITY
CA
94065
0
0
1
0
Series A Convertible Preferred Stock
Class A Common Stock
6659530.0
D
Series B Convertible Preferred Stock
Class A Common Stock
3270280.0
D
Series B-1 Convertible Preferred Stock
Class A Common Stock
487100.0
D
Series C Convertible Preferred Stock
Class A Common Stock
731410.0
D
Each share of Convertible Preferred Stock was initially convertible on a one-for-one basis into the Issuer's Class A Common Stock at any time at the holder's election and has no expiration date. The number of underlying shares of common stock reported in Column 3 gives effect to a 10-for-1 forward stock split effective as of October 27, 2021, pursuant to which each share of Convertible Preferred Stock became convertible into 10 shares of Class A Common Stock. The Convertible Preferred Stock will convert automatically upon closing of the Issuer's initial public offering.
FBHR Associates, LLC is the manager of Hillsven, LLC and in such capacity may be deemed to share voting and investment power over such securities. James G.B. DeMartini, III, as trustee of Unameit Trust, is the manager of FBHR Associates, LLC, and in such capacity may be deemed to share voting and investment power over such securities.
/s/ James G.B. DeMartini, III, Managing Member of Hillsven LLC
2021-11-09
/s/ James G.B. DeMartini, III, trustee of Unameit Trust, Managing Member of FBHR Associates LLC
2021-11-09
/s/ James G.B. DeMartini, III, trustee of Unameit Trust
2021-11-09
/s/ James G.B. DeMartini, III
2021-11-09