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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT 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 1474 (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 Following Reported Transaction(s) (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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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Draper Fisher Jurvetson Fund VI, L.P. 2882 SAND HILL ROAD, SUITE 150 MENLO PARK, CA 94025 |
X | |||
DRAPER TIMOTHY C 2882 SAND HILL ROAD, SUITE 150 MENLO PARK, CA 94025 |
X | |||
Fisher John H N 2882 SAND HILL ROAD, SUITE 150 MENLO PARK, CA 94025 |
X | |||
Jurvetson Stephen T 2882 SAND HILL ROAD, SUITE 150 MENLO PARK, CA 94025 |
X | |||
Draper Fisher Jurvetson Management Co. VI, LLC 2882 SAND HILL ROAD, SUITE 150 MENLO PARK, CA 94025 |
X | |||
Draper Fisher Jurvetson Partners VI, LLC 2882 SAND HILL ROAD, SUITE 150 MENLO PARK, CA 94025 |
X |
/s/ Timothy C. Draper | 03/24/2008 | |
**Signature of Reporting Person | Date | |
/s/ John H. N. Fisher | 03/24/2008 | |
**Signature of Reporting Person | Date | |
/s/ Stephen T. Jurvetson | 03/24/2008 | |
**Signature of Reporting Person | Date | |
/s/ Timothy C. Draper, Managing Member, Draper Fisher Jurvetson Management Co. VI, LLC (General Partner) for Draper Fisher Jurvetson Fund VI, L.P. | 03/24/2008 | |
**Signature of Reporting Person | Date | |
/s/ Timothy C. Draper, Managing Member for Draper Fisher Jurvetson Management Co. VI, LLC | 03/24/2008 | |
**Signature of Reporting Person | Date | |
/s/ Timothy C. Draper, Managing Member for Draper Fisher Jurvetson Partners VI, LLC | 03/24/2008 | |
**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) | On March 20, 2008, Draper Fisher Jurvetson Fund VI ("Fund VI"), made an in-kind distribution, without any additional consideration, of Common Stock of AthenaHealth, Inc. to the limited and general partner of Fund VI. In turn, the general partner will make an in-kind distribution of the shares it received to its members. |
(2) | Represents shares owned directly by Draper Fisher Jurvetson Fund VI, L.P. ("Fund VI"). |
(3) | Represents shares owned directly by Draper Fisher Jurvetson Management Co. VI, LLC ("General Partner"). |
(4) | On March 20, 2008, Draper Fisher Jurvetson Partners VI, LLC (the "Side Fund") made an in-kind distribution, without any additional consideration, of Common Stock of AthenaHealth, Inc. to its members. Represents shares owned directly by Draper Fisher Jurvetson Partners VI, LLC. |
(5) | Represents 26,686 shares owned directly by Mr. Draper, represents 4,995 shares held through Fund VI, 47,350 shares held through the General Partner of Fund VI and 5,530 shares held through Draper Associates, L.P. of which Mr. Draper is the President of the General Partner. |
(6) | Represents 18,026 shares owned directly by Mr. Fisher, 18,026 shares held through the Side Fund, 45,957 shares held through the General Partner of Fund VI and 4,848 shares held through Fund VI. |
(7) | Represents 10,674 shares owned directly by Mr. Jurvetson, 10,674 shares held through the Side Fund, 45,957 shares held through the General Partner of Fund VI and 4,848 shares held through Fund VI. |
Remarks: This Form 4 is filed on behalf of (i) Draper Fisher Jurvetson Fund VI, L.P., a California limited partnership; (ii) Draper Fisher Jurvetson Management Co. VI, LLC, a California limited liability company, (iii) Draper Fisher Jurvetson Partners VI, LLC, a California limited liability company; (iv) Timothy C. Draper, a United States citizen ("Draper"); John H. N. Fisher, a United States citizen ("Fisher") and Stephen T. Jurvetson, a United States citizen ("Jurvetson"). Relationships: (1) Draper Fisher Jurvetson Fund VI, L.P. is a California limited partnership ("Fund VI"). (2) Draper Fisher Jurvetson Management Co. VI, LLC (the "General Partner") is the general partner of Fund VI. The managing members of the general partner of Fund VI are Messrs. Draper, Fisher and Jurvetson. (3) Draper Fisher Jurvetson Partners VI, LLC (the "Side Fund") is a side-by-side fund of Fund VI. The managing members of the Side Fund are Messrs. Draper, Fisher and Jurvetson. Decisions with respect to Side Fund securities are made automatically in conjunction with decisions by Fund VI. Messrs. Draper, Fisher and Jurvetson disclaim beneficial ownership of the shares held directly by Fund VI, the General Partner of Fund VI and the Side Fund to Fund VI, except to the extent of their pecuniary interest therein. |