0001104659-21-024605.txt : 20210216
0001104659-21-024605.hdr.sgml : 20210216
20210216215142
ACCESSION NUMBER: 0001104659-21-024605
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20201231
FILED AS OF DATE: 20210216
DATE AS OF CHANGE: 20210216
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Andrews Christopher
CENTRAL INDEX KEY: 0001817926
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39441
FILM NUMBER: 21642420
MAIL ADDRESS:
STREET 1: 228 PARK AVENUE SOUTH
STREET 2: SUITE 72602
CITY: NEW YORK
STATE: NY
ZIP: 10003
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Kubient, Inc.
CENTRAL INDEX KEY: 0001729750
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER INTEGRATED SYSTEMS DESIGN [7373]
IRS NUMBER: 821808844
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 228 PARK AVENUE
STREET 2: SOUTH SUITE 72602
CITY: NEW YORK
STATE: NY
ZIP: 10003
BUSINESS PHONE: (800) 409-9456
MAIL ADDRESS:
STREET 1: 228 PARK AVENUE
STREET 2: SOUTH SUITE 72602
CITY: NEW YORK
STATE: NY
ZIP: 10003
5
1
tm216792d5_5.xml
OWNERSHIP DOCUMENT
X0306
5
2020-12-31
0
0
0
0001729750
Kubient, Inc.
KBNT
0001817926
Andrews Christopher
C/O KUBIENT, INC.
228 PARK AVENUE SOUTH, SUITE 72602
NEW YORK
NY
10003
0
0
0
1
Former Chief Digital Officer
Common Stock
2020-08-14
5
C
0
128522
A
130745
D
Common Stock Purchase Warrant
5.50
2020-08-14
5
C
0
128522
A
2020-08-14
2025-08-14
Common Stock
128522
128522
D
Represents the shares of common stock of Kubient, Inc. (the "Company") issued upon conversion of $480,124 of promissory notes that, upon the initial public offering of the Company, converted into 128,522 immediately-separable units composed of (i) one share of common stock, and (ii) one warrant to purchase one share of common stock at a price of $5.50 per share.
Not previously reported on Form 4.
Does not include 6,240 shares of common stock underlying stock options exercisable within 60 days. Also does not include 128,522 shares of common stock underlying five-year warrants issued on August 14, 2020, which are reported on Table II of this Form 5. Additionally, does not include 102,857 immediately-separable units composed of (i) one share of common stock, and (ii) one warrant to purchase one share of common stock at a price of $5.50 per share, underlying five-year warrants issued on November 6, 2019.
Represents the warrants to purchase shares of common stock issued upon conversion of $480,124 of promissory notes that, upon the initial public offering of the Company, converted into 128,522 immediately-separable units composed of (i) one share of common stock, and (ii) one warrant to purchase one share of common stock at a price of $5.50 per share.
/s/ Christopher Andrews
2021-02-15