0001140361-17-038919.txt : 20171017 0001140361-17-038919.hdr.sgml : 20171017 20171017184214 ACCESSION NUMBER: 0001140361-17-038919 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171016 FILED AS OF DATE: 20171017 DATE AS OF CHANGE: 20171017 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: 171141507 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 2017-10-16 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 Common Stock 2017-10-16 4 C 0 12466 A 12466 I See Footnote Common Stock 2017-10-16 4 C 0 13650 A 26116 I See Footnote Common Stock 2017-10-16 4 C 0 16643 A 42759 I See Footnote Common Stock 2017-10-16 4 C 0 2282 7 A 45041 I See Footnote Common Stock 2017-10-16 4 C 0 461717 A 461717 I See Footnote Common Stock 2017-10-16 4 C 0 505580 A 967297 I See Footnote Common Stock 2017-10-16 4 C 0 616446 A 1583743 I See Footnote Common Stock 2017-10-16 4 C 0 84526 7 A 1668269 I See Footnote Common Stock 2017-10-16 4 C 0 474184 A 474184 I See Footnote Common Stock 2017-10-16 4 C 0 519230 A 993414 I See Footnote Common Stock 2017-10-16 4 C 0 633094 A 1626508 I See Footnote Common Stock 2017-10-16 4 C 0 86809 7 A 1713317 I See Footnote Series A Preferred Stock 2017-10-16 4 C 0 12466 D Common Stock 12466 0 I See Footnote Series A Preferred Stock 2017-10-16 4 C 0 461717 D Common Stock 461717 0 I See Footnote Series A Preferred Stock 2017-10-16 4 C 0 474184 D Common Stock 474184 0 I See Footnote Series B Preferred Stock 2017-10-16 4 C 0 13650 D Common Stock 13650 0 I See Footnote Series B Preferred Stock 2017-10-16 4 C 0 505580 D Common Stock 505580 0 I See Footnote Series B Preferred Stock 2017-10-16 4 C 0 519230 D Common Stock 519230 0 I See Footnote Series C Preferred Stock 2017-10-16 4 C 0 16643 D Common Stock 16643 0 I See Footnote Series C Preferred Stock 2017-10-16 4 C 0 616446 D Common Stock 616446 0 I See Footnote Series C Preferred Stock 2017-10-16 4 C 0 633094 D Common Stock 633094 0 I See Footnote Convertible Promissory Note 7 2017-10-16 4 C 0 15888.66 D Common Stock 2282 0 I See Footnote Convertible Promissory Note 7 2017-10-16 4 C 0 588463.1 D Common Stock 84526 0 I See Footnote Convertible Promissory Note 7 2017-10-16 4 C 0 604351.76 D Common Stock 86809 0 I See Footnote The shares of the Issuer's Preferred Stock automatically converted into shares of the Issuer's Common Stock, for no additional consideration, on a 1:1 basis immediately prior to the consummation of the Issuer's Initial Public Offering (the "IPO"). 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. The expiration date is not relevant to the conversion of these securities. The amount reported in column 5 is the principal amount of Reporting Person's Convertible Promissory Note (the "Note"). The outstanding principal and accrued interest of the Note automatically converted 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 Issuer's IPO upon the closing of the IPO. /s/ Charlotte Holland, Attorney-in-Fact for Craig C Taylor 2017-10-16