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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | 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 control number. | SEC 2270 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Class A Common Stock | Â | 05/23/2016 | Â | G | Â | 54,096 | Â (1)(2) | Â (1)(2) | Class B Common Stock (2) | $ 0 | 4,350,753 | By living trust (3) | ||
Class A Common Stock | Â | Â | Â | Â | Â | Â | Â (1)(2) | Â (1)(2) | Class B Common Stock (2) | Â | 600,000 | By grantor retained annuity trust 1 (4) | ||
Class A Common Stock | Â | Â | Â | Â | Â | Â | Â (1)(2) | Â (1)(2) | Class B Common Stock (2) | Â | 250,000 | By grantor retained annuity trust 2 (4) | ||
Class A Common Stock | Â | Â | Â | Â | Â | Â | Â (1)(2) | Â (1)(2) | Class B Common Stock (2) | Â | 600,000 | By grantor retained annuity trust 3 (5) | ||
Class A Common Stock | Â | Â | Â | Â | Â | Â | Â (1)(2) | Â (1)(2) | Class B Common Stock (2) | Â | 250,000 | By grantor retained annuity trust 4 (5) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Colella Giovanni M. C/O CASTLIGHT HEALTH, INC. 150 SPEAR ST., SUITE 400 SAN FRANCISCO, CA 94105 |
 X |  |  CEO and Co-Founder |  |
/s/ Charles Ott, by power of attorney | 02/13/2017 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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). |
(1) | Each share of Class A Common Stock is convertible, at any time at the option of the holder, into one (1) share of Class B Common Stock. In addition, each share of Class A Common Stock will convert automatically into one (1) share of Class B Common Stock upon the transfer, whether or not for value, that occurs after the closing of the IPO to any transferee who is not a "Permitted Transferee", as defined in the Issuer's Restated Certificate of Incorporation in effect as of the date hereof. The shares of Class A Common Stock have no expiration date. |
(2) | Each share of the Issuer's Class A Common Stock will convert automatically into one (1) share of Class B Common Stock upon the earliest to occur of the following: (a) the first date on which the number of shares of Class A Common Stock then outstanding is less than 15,340,384 shares, (b) March 19, 2024, or (c) a time and date approved in writing by holders of at least a majority of the then-outstanding shares of Class A Common Stock. The shares of Class A Common Stock and Class B Common Stock have no expiration date. |
(3) | Reporting Person serves as a co-trustee. |
(4) | Reporting Person serves as trustee and sole beneficiary. |
(5) | Reporting Person's spouse serves as trustee and sole beneficiary. |