0001140361-17-038668.txt : 20171013
0001140361-17-038668.hdr.sgml : 20171013
20171013185244
ACCESSION NUMBER: 0001140361-17-038668
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171011
FILED AS OF DATE: 20171013
DATE AS OF CHANGE: 20171013
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: TAYLOR CRAIG C
CENTRAL INDEX KEY: 0000939105
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38238
FILM NUMBER: 171137369
MAIL ADDRESS:
STREET 1: 400 HAMILTON AVE.
STREET 2: 4TH FLOOR
CITY: PALO ALTO
STATE: CA
ZIP: 94301
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Restoration Robotics Inc
CENTRAL INDEX KEY: 0001409269
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 061681204
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 128 BAYTECH DRIVE
CITY: SAN JOSE
STATE: CA
ZIP: 95134
BUSINESS PHONE: 408-883-6888
MAIL ADDRESS:
STREET 1: 128 BAYTECH DRIVE
CITY: SAN JOSE
STATE: CA
ZIP: 95134
4
1
doc1.xml
FORM 4
X0306
4
2017-10-11
0
0001409269
Restoration Robotics Inc
HAIR
0000939105
TAYLOR CRAIG C
C/O RESTORATION ROBOTICS, INC.
128 BAYTECH DRIVE
SAN JOSE
CA
95134
1
0
1
0
Convertible Promissory Note
7
2017-10-11
4
J
0
15888.66
15888.66
A
Common Stock
15888.66
I
See Footnote
Convertible Promissory Note
7
2017-10-11
4
J
0
588463.1
588463.1
A
Common Stock
588463.1
I
See Footnote
Convertible Promissory Note
7
2017-10-11
4
J
0
604351.76
604351.76
A
Common Stock
604351.76
I
See Footnote
The securities were originally acquired from the Issuer on September 6, 2017; however, the conversion price was set upon the pricing of the Issuer's Initial Public Offering (the "IPO").
The amount reported represents the principal amount of the Reporting Person's Convertible Promissory Note (the "Note") only. Accrued interest of 5% per year based on the actual number of days outstanding through the conversion date will also convert.
The outstanding principal and accrued interest of the Note automatically converts into shares of the Issuer's Common Stock at the price per share available to the public as set forth in the final prospectus related to the IPO upon the closing of the IPO; if not so converted, the Note has a maturity date of September 6, 2018, at which time it will automatically convert into shares of the Issuer's capital stock.
The securities are directly held by Alloy Partners 2002, L.P. ("Alloy Partners 2002"). Alloy Ventures 2002, LLC ("Ventures 2002"), as the sole general partner of Alloy Partners 2002, may be deemed to beneficially own the securities held by Alloy Partners 2002. The Reporting Person is a managing director of Ventures 2002, and as such may be deemed to beneficially own the securities held by Alloy Partners 2002. The Reporting Person disclaims beneficial ownership of such securities except to the extent of any pecuniary interest therein.
The securities are directly held by Alloy Ventures 2002, L.P. ("Alloy Ventures 2002"). Ventures 2002, as the sole general partner of Alloy Ventures 2002, may be deemed to beneficially own the securities held by Alloy Ventures 2002. The Reporting Person is a managing director of Ventures 2002, and as such may be deemed to beneficially own the securities held by Alloy Ventures 2002. The Reporting Person disclaims beneficial ownership of such securities except to the extent of any pecuniary interest therein.
The securities are directly held by Alloy Ventures 2005, L.P. ("Alloy Ventures 2005"). Alloy Ventures 2005, LLC ("Ventures 2005"), as the sole general partner of Alloy Ventures 2005, may be deemed to beneficially own the securities held by Alloy Ventures 2005. The Reporting Person is a managing director of Ventures 2005, and as such may be deemed to beneficially own the securities held by Alloy Ventures 2005. The Reporting Person disclaims beneficial ownership of such securities except to the extent of any pecuniary interest therein.
/s/ Charlotte Holland, Attorney-in-Fact for Craig C Taylor
2017-10-13