0001209191-15-056511.txt : 20150625
0001209191-15-056511.hdr.sgml : 20150625
20150625184353
ACCESSION NUMBER: 0001209191-15-056511
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150625
FILED AS OF DATE: 20150625
DATE AS OF CHANGE: 20150625
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Xactly Corp
CENTRAL INDEX KEY: 0001322554
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 113744289
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0131
BUSINESS ADDRESS:
STREET 1: 300 PARK AVENUE, SUITE 1700
CITY: SAN JOSE
STATE: CA
ZIP: 95110
BUSINESS PHONE: (408) 977-3132
MAIL ADDRESS:
STREET 1: 300 PARK AVENUE, SUITE 1700
CITY: SAN JOSE
STATE: CA
ZIP: 95110
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Di Bona Tony
CENTRAL INDEX KEY: 0001316825
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37451
FILM NUMBER: 15952851
MAIL ADDRESS:
STREET 1: 400 HAMILTON AVENUE
STREET 2: 4TH FLOOR
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Hanafi Ammar
CENTRAL INDEX KEY: 0001316968
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37451
FILM NUMBER: 15952852
MAIL ADDRESS:
STREET 1: 400 HAMILTON AVENUE
STREET 2: 4TH FLOOR
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Hunkapiller Michael
CENTRAL INDEX KEY: 0001317102
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37451
FILM NUMBER: 15952853
MAIL ADDRESS:
STREET 1: 400 HAMILTON AVENUE
STREET 2: 4TH FLOOR
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Rubin Daniel
CENTRAL INDEX KEY: 0001316624
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37451
FILM NUMBER: 15952854
MAIL ADDRESS:
STREET 1: 480 COWPER ST.
STREET 2: 2ND FL.
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: KELLY DOUGLAS E
CENTRAL INDEX KEY: 0001227887
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37451
FILM NUMBER: 15952855
MAIL ADDRESS:
STREET 1: 400 HAMILTON AVENUE
STREET 2: 4TH FLOOR
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: TAYLOR CRAIG C
CENTRAL INDEX KEY: 0000939105
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37451
FILM NUMBER: 15952856
MAIL ADDRESS:
STREET 1: 400 HAMILTON AVE.
STREET 2: 4TH FLOOR
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ALLOY VENTURES 2005 LP
CENTRAL INDEX KEY: 0001333202
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37451
FILM NUMBER: 15952857
BUSINESS ADDRESS:
STREET 1: 400 HAMILTON AVENUE
STREET 2: 4TH FLOOR
CITY: PALO ALTO
STATE: CA
ZIP: 94301
BUSINESS PHONE: 6506875000
MAIL ADDRESS:
STREET 1: 400 HAMILTON AVENUE
STREET 2: 4TH FLOOR
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Alloy Ventures 2005, LLC
CENTRAL INDEX KEY: 0001355724
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37451
FILM NUMBER: 15952858
BUSINESS ADDRESS:
STREET 1: 400 HAMILTON AVENUE, 4TH FLOOR
CITY: PALO ALTO
STATE: CA
ZIP: 94301
BUSINESS PHONE: (650) 687-5000
MAIL ADDRESS:
STREET 1: 400 HAMILTON AVENUE, 4TH FLOOR
CITY: PALO ALTO
STATE: CA
ZIP: 94301
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2015-06-25
0
0001322554
Xactly Corp
XTLY
0001355724
Alloy Ventures 2005, LLC
400 HAMILTON AVENUE,
4TH FLOOR
PALO ALTO
CA
94301
0
0
1
0
0001333202
ALLOY VENTURES 2005 LP
400 HAMILTON AVENUE,
4TH FLOOR
PALO ALTO
CA
94301
0
0
1
0
0000939105
TAYLOR CRAIG C
400 HAMILTON AVENUE,
4TH FLOOR
PALO ALTO
CA
94301
0
0
1
0
0001227887
KELLY DOUGLAS E
400 HAMILTON AVENUE,
4TH FLOOR
PALO ALTO
CA
94301
0
0
1
0
0001316624
Rubin Daniel
400 HAMILTON AVENUE,
4TH FLOOR
PALO ALTO
CA
94301
0
0
1
0
0001317102
Hunkapiller Michael
400 HAMILTON AVENUE,
4TH FLOOR
PALO ALTO
CA
94301
0
0
1
0
0001316968
Hanafi Ammar
400 HAMILTON AVENUE,
4TH FLOOR
PALO ALTO
CA
94301
0
0
1
0
0001316825
Di Bona Tony
400 HAMILTON AVENUE,
4TH FLOOR
PALO ALTO
CA
94301
0
0
1
0
Series A Convertible Preferred Stock
Common Stock
5398
I
See footnote
Series B Convertible Preferred Stock
Common Stock
2858
I
See footnote
Series C Convertible Preferred Stock
Common Stock
1772524
I
See footnote
Series D Convertible Preferred Stock
Common Stock
460281
I
See footnote
Series D-1 Convertible Preferred Stock
Common Stock
105168
I
See footnote
Series F Convertible Preferred Stock
Common Stock
40693
I
See footnote
Series F Convertible Preferred Stock Warrant (right to buy)
9.83
Series F Convertible Preferred Stock
10173
I
See footnote
The Series A Convertible Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of common stock and has no expiration date.
All shares are held of record by Alloy Ventures 2005, L.P. ("Alloy Ventures 2005"). Craig C. Taylor, Douglas E. Kelly, John F. Shoch, Tony Di Bona, Daniel Rubin, Michael W. Hunkapiller and Ammar H. Hanafi are the managing members of Alloy Ventures 2005, LLC, the general partner of Alloy Ventures 2005, and share voting and dispositive power over the shares held by Alloy Ventures 2005. Each of the Reporting Persons disclaims beneficial ownership of these shares except to the extent of any pecuniary interest therein, and the filing of this report is not an admission that any Reporting Person is the beneficial owner of these shares for purposes of Section 16 or for any other purpose.
The Series B Convertible Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of common stock and has no expiration date.
The Series C Convertible Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of common stock and has no expiration date.
The Series D Convertible Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of common stock and has no expiration date.
The Series D-1 Convertible Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of common stock and has no expiration date.
The Series F Convertible Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of common stock and has no expiration date.
The Series F Convertible Preferred Stock Warrant is immediately exercisable and expires upon completion of the Issuer's initial public offering of common stock.
/s/ Tony Di Bona, managing member of Alloy Ventures 2005, LLC
2015-06-25
/s/ Tony Di Bona, managing member of Alloy Ventures 2005, LLC, the general partner of Alloy Ventures 2005, L.P.
2015-06-25
/s/ Tony Di Bona by power of attorney for Craig C. Taylor
2015-06-25
/s/ Tony Di Bona by power of attorney for Douglas E. Kelly
2015-06-25
/s/ Tony Di Bona by power of attorney for John F. Shoch
2015-06-25
/s/ Tony Di Bona by power of attorney for Daniel Rubin
2015-06-25
/s/ Tony Di Bona by power of attorney for Michael W. Hunkapiller
2015-06-25
/s/ Tony Di Bona by power of attorney for Ammar H. Hanafi
2015-06-25
/s/ Tony Di Bona
2015-06-25