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