0000899243-21-029362.txt : 20210721 0000899243-21-029362.hdr.sgml : 20210721 20210721201227 ACCESSION NUMBER: 0000899243-21-029362 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210721 FILED AS OF DATE: 20210721 DATE AS OF CHANGE: 20210721 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mayfield XIII, a Cayman Islands Exempted Limited Partnership CENTRAL INDEX KEY: 0001573272 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40601 FILM NUMBER: 211105701 BUSINESS ADDRESS: STREET 1: 2484 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-854-5560 MAIL ADDRESS: STREET 1: 2484 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mayfield XIII Management (EGP), L.P., a Cayman Islands Exempted Limited Partnership CENTRAL INDEX KEY: 0001573273 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40601 FILM NUMBER: 211105700 BUSINESS ADDRESS: STREET 1: 2484 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-854-5560 MAIL ADDRESS: STREET 1: 2484 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mayfield XIII Management (UGP), Ltd., a Cayman Islands Exempted Co. CENTRAL INDEX KEY: 0001573274 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40601 FILM NUMBER: 211105699 BUSINESS ADDRESS: STREET 1: 2484 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-854-5560 MAIL ADDRESS: STREET 1: 2484 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 FORMER NAME: FORMER CONFORMED NAME: Mayfield XIII Management (UGP), Ltd., a Cayman Islands Exempted Co DATE OF NAME CHANGE: 20130328 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Couchbase, Inc. CENTRAL INDEX KEY: 0001845022 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 263576987 STATE OF INCORPORATION: DE FISCAL YEAR END: 0131 BUSINESS ADDRESS: STREET 1: 3250 OLCOTT STREET CITY: SANTA CLARA STATE: CA ZIP: 95054 BUSINESS PHONE: 6504177500 MAIL ADDRESS: STREET 1: 3250 OLCOTT STREET CITY: SANTA CLARA STATE: CA ZIP: 95054 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2021-07-21 0 0001845022 Couchbase, Inc. BASE 0001573272 Mayfield XIII, a Cayman Islands Exempted Limited Partnership 2484 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001573273 Mayfield XIII Management (EGP), L.P., a Cayman Islands Exempted Limited Partnership C/O MAYFIELD, 2484 SAND HILL ROAD MENLO PARK 94025 0 0 1 0 0001573274 Mayfield XIII Management (UGP), Ltd., a Cayman Islands Exempted Co. C/O MAYFIELD, 2484 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 Common Stock 90045 I Mayfield XIII, a Cayman Islands Exempted Limited Partnership Series B Preferred Stock 0.00 Common Stock 1909090 I Mayfield XIII, a Cayman Islands Exempted Limited Partnership Series C Preferred Stock 0.00 Common Stock 715278 I Mayfield XIII, a Cayman Islands Exempted Limited Partnership Series D Preferred Stock 0.00 Common Stock 258017 I Mayfield XIII, a Cayman Islands Exempted Limited Partnership Series E Preferred Stock 0.00 Common Stock 127014 I Mayfield XIII, a Cayman Islands Exempted Limited Partnership Series F Preferred Stock 0.00 Common Stock 169212 I Mayfield XIII, a Cayman Islands Exempted Limited Partnership Series G Preferred Stock 0.00 Common Stock 72824 I Mayfield XIII, a Cayman Islands Exempted Limited Partnership These shares are held of record by Mayfield XIII, a Cayman Islands Exempted Limited Partnership, or MF XIII. Mayfield XIII Management (UGP), Ltd., a Cayman Islands Exempted Company, or MF XIII UGP, is the general partner of Mayfield XIII Management (EGP), L.P., a Cayman Islands Exempted Limited Partnership, which is the general partner of MF XIII. Rajeev Batra, Navin Chaddha and Vaneeta Varma are the directors of MF XIII UGP. As a result, each of the foregoing entities and individuals may be deemed to share beneficial ownership of the shares owned by MF XIII, but each such entity or person disclaims such beneficial ownership except to the extent of its or their pecuniary interest therein. Immediately prior to the completion of the Issuer's initial public offering, each share of Series B Preferred Stock, Series C Preferred Stock, Series D Preferred Stock and Series F Preferred Stock is convertible into shares of the Issuer's Common Stock on a one-for-one basis and has no expiration date. Immediately prior to the completion of the Issuer's initial public offering, each share of Series E Preferred Stock is convertible into shares of the Issuer's Common Stock on a 1.05279880234039-for-one basis and has no expiration date. Immediately prior to the completion of the Issuer's initial public offering, each share of Series G Preferred Stock is convertible into shares of the Issuer's Common Stock on a an expected 1.06673317089756-for-one basis and has no expiration date. Mayfield XIII, a Cayman Islands Exempted Limited Partnership, By: Mayfield XIII Management (EGP), L.P., its general partner, By: Mayfield XIII Management (UGP), Ltd., its general partner, /s/ Paul Kohli, Authorized Signatory 2021-07-21 Mayfield XIII Management (EGP), L.P., By: Mayfield XIII Management (UGP), Ltd., its general partner, /s/ Paul Kohli, Authorized Signatory 2021-07-21 Mayfield XIII Management (UGP), Ltd., /s/ Paul Kohli, Authorized Signatory 2021-07-21