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