FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 09/19/2018 |
3. Issuer Name and Ticker or Trading Symbol
Eventbrite, Inc. [ EB ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Common Stock | (1) | (1) | Common Stock(1) | 1,000,000 | (1) | D | |
Common Stock | (1) | (1) | Common Stock(1) | 3,837,734 | (1) | I | See Footnote(2) |
Common Stock | (1) | (1) | Common Stock(1) | 2,627,266 | (1) | I | See Footnote(3) |
Stock Option (Right to Buy) | (4) | 02/27/2023 | Common Stock(1) | 250,000 | $2.41 | D | |
Stock Option (Right to Buy) | (5) | 05/24/2025 | Common Stock(1) | 75,000 | $6.65 | D | |
Stock Option (Right to Buy) | (6) | 05/18/2026 | Common Stock(1) | 1,552,468 | $7.4 | D | |
Stock Option (Right to Buy) | (7) | 07/23/2028 | Common Stock(1) | 2,877,468 | $13.72 | D | |
Stock Option (Right to Buy) | (4) | 02/27/2023 | Common Stock(1) | 1,250,000 | $2.41 | I | See Footnote(8) |
Restricted Stock Units(9) | (10) | 12/31/2024 | Common Stock(1) | 802,900 | (9) | I | See Footnote(11) |
Series A Convertible Preferred Stock | (12) | (12) | Common Stock(1) | 403,259 | (12) | I | See Footnote(2) |
Series G Convertible Preferred Stock | (13) | (13) | Common Stock(1) | 30,518 | (13) | I | See Footnote(2) |
Explanation of Responses: |
1. Each share of common stock will be reclassified into one share of Class B common stock immediately prior to the completion of the Issuer's initial public offering of Class A common stock. |
2. The shares are owned by the Kevin Earnest Hartz & Julia D. Hartz TTEES the Hartz Family Revocable Trust Dtd 12/4/08 of which the Reporting Person is a co-trustee. |
3. The shares are owned by The Hartz 2008 Irrevocable Trust, dated September 15, 2008 of which the Reporting Person is a co-trustee. |
4. The stock option was immediately exercisable as of the date of grant subject to a repurchase right in favor of the company and vested in 48 equal monthly installments from February 13, 2013 through February 13, 2017. |
5. The stock option was immediately exercisable as of the date of grant subject to a repurchase right in favor of the company and vests in 48 equal monthly installments from May 1, 2015 through May 1, 2019, subject to the Reporting Person's continued service to the Issuer. |
6. The stock option was immediately exercisable as of the date of grant subject to a repurchase right in favor of the company and vests in 48 equal monthly installments from May 19, 2016 through May 19, 2020, subject to the Reporting Person's continued service to the Issuer. |
7. The stock option vests and becomes exercisable in 48 equal monthly installments from May 31, 2018 through May 31, 2022, subject to the Reporting Person's continued service to the Issuer. |
8. The stock option is held by Kevin Hartz, who is the Chairman of the Issuer's Board of Directors and the spouse of the Reporting Person, and as such may be deemed to be beneficially held by the Reporting Person. |
9. Each restricted stock unit ("RSU") is convertible into one share of common stock. |
10. The RSUs will vest upon the closing of the Issuer's initial public offering. |
11. The restricted stock units are held by Kevin Hartz, who is the Chairman of the Issuer's Board of Directors and the spouse of the Reporting Person, and as such may be deemed to be beneficially held by the Reporting Person. |
12. Each share of Series A preferred stock automatically converts into common stock on a 1:1 basis immediately prior to the closing of the Issuer's initial public offering of Class A common stock and has no expiration date or conversion price. Immediately prior to the completion of the Issuer's initial public offering, all shares of common stock will be converted into shares of Class B common stock. |
13. The Series G preferred stock is convertible into common stock on an approximately 1:1.0685 basis and has no expiration date. Immediately prior to the completion of the Issuer's initial public offering, all shares of common stock will be converted into shares of Class B common stock. |
Remarks: |
Exhibit 24.1 - Power of Attorney |
/s/ Samantha Harnett, attorney-in-fact of the Reporting Person | 09/19/2018 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |