0001209191-16-143274.txt : 20160930
0001209191-16-143274.hdr.sgml : 20160930
20160930154737
ACCESSION NUMBER: 0001209191-16-143274
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160930
FILED AS OF DATE: 20160930
DATE AS OF CHANGE: 20160930
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: DETERMINE, INC.
CENTRAL INDEX KEY: 0001090908
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 770432030
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0331
BUSINESS ADDRESS:
STREET 1: 2121 SOUTH EL CAMINO REAL
STREET 2: 10TH FLOOR
CITY: SAN MATEO
STATE: CA
ZIP: 94403
BUSINESS PHONE: 650-532-1500
MAIL ADDRESS:
STREET 1: 2121 SOUTH EL CAMINO REAL
STREET 2: 10TH FLOOR
CITY: SAN MATEO
STATE: CA
ZIP: 94403
FORMER COMPANY:
FORMER CONFORMED NAME: SELECTICA INC
DATE OF NAME CHANGE: 19991203
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MILLER LLOYD I III
CENTRAL INDEX KEY: 0000949119
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-29637
FILM NUMBER: 161912825
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2016-09-30
0
0001090908
DETERMINE, INC.
DTRM
0000949119
MILLER LLOYD I III
3300 SOUTH DIXIE HIGHWAY
SUITE 1-365
WEST PALM BEACH
FL
33405
0
0
1
0
Common Stock
2016-09-30
4
J
0
4043
3.75
A
39257
D
Common Stock
2016-09-30
4
J
0
4043
3.75
A
709817
I
By Trust A-4 - Lloyd I. Miller
Common Stock
2016-09-30
4
J
0
4043
3.75
A
1141754
I
By Milfam II L.P.
Common Stock
87410
I
By Milgrat (D10)
Common Stock
247180
I
By Trust C - Lloyd I. Miller
Common Stock
2100
I
By Trust D - Lloyd I. Miller
Common Stock
211351
I
By Milfam I L.P.
Junior Secured Convertible Promissory Note
3.75
2015-12-16
2020-12-16
Common Stock
160000
160000
D
Junior Secured Convertible Promissory Note
3.75
2015-12-16
2020-12-16
Common Stock
160000
160000
I
By Milfam II L.P.
Junior Secured Convertible Promissory Note
3.75
2015-12-16
2020-12-16
Common Stock
160000
160000
I
By Trust A-4 - Lloyd I. Miller
Warrant
6.00
Common Stock
79787
79787
I
By Milfam I L.P.
Warrant
6.00
Common Stock
79787
79787
I
By Milfam II L.P.
Warrant
6.00
Common Stock
79787
79787
I
By Trust C - Lloyd I. Miller
Junior Secured Convertible Promissory Notes
5.70
2020-12-16
Common Stock
175438.59
175438.59
I
By Milfam II L.P.
Junior Secured Convertible Promissory Notes
5.70
2020-12-16
Common Stock
175438.59
175438.59
I
By Trust A-4 - Lloyd I. Miller
Junior Secured Convertible Promissory Notes
5.70
2020-12-16
Common Stock
175438.59
175438.59
D
Warrant
7.00
2014-08-27
2019-08-27
Common Stock
49401
49401
I
By Trust A-4 - Lloyd I. Miller
Warrant
7.00
2014-08-27
2019-08-27
Common Stock
13722
13722
I
By Milgrat (D10)
Warrant
7.00
2014-08-27
2019-08-27
Common Stock
74102
74102
I
By Milfam II L.P.
Warrant
7.00
2014-07-24
2019-07-24
Common Stock
57558
57558
I
By Trust A-4 - Lloyd I. Miller
Warrant
7.00
2014-07-24
2019-07-24
Common Stock
15988
15988
I
By Milgrat (D10)
Warrant
7.00
2014-07-24
2019-07-24
Common Stock
86338
86338
I
By Milfam II L.P.
Series A Warrant
7.75
2013-12-01
2018-05-31
Common Stock
40894
40894
I
By Trust A-4 - Lloyd I. Miller
Series A Warrant
7.75
2013-12-01
2018-05-31
Common Stock
11359
11359
I
By Milgrat (D10)
Series A Warrant
7.75
2013-12-01
2018-05-31
Common Stock
61342
61342
I
By Milfam II L.P.
Accrued interest on the junior secured convertible promissory note paid in the form of common stock by converting such accrued interest amount to common stock at the conversion price of $3.75.
The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. This filing shall not be deemed an admission that the reporting person is, for purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, the beneficial owner of any equity securities covered by this filing.
Such Warrant will be exercisable six months following the date of issuance, February 6, 2015.
Such Warrant will expire on the fifth anniversary of the exercisability date.
As previously reported, the issuer entered into a binding term sheet with the reporting person pursuant to which the issuer agreed to issue and the reporting person agreed to purchase, junior secured convertible promissory notes in the aggregate principal amount of $3 million subject to negotiation and execution of definitive documentation. On March 11, 2015, the notes were executed and on May 5, 2015, the shareholders approved the conversion of the notes at the stockholders meeting.
The issuer and the reporting person agreed to amend the maturity date from March 11, 2020 to December 16, 2020.
Subject to adjustment for fractional shares.
/s/ David J. Hoyt
Attorney-in-fact
2016-09-30