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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 | ||||||||
STOCK OPTION | $ 1.08 | 05/08/2009 | A | 20,000 | 08/08/2009(1) | 05/08/2019 | COMMON STOCK | 20,000 | $ 0 | 252,808 (2) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
KAGLE ROBERT C/O JAMBA, INC. 6475 CHRISTIE AVENUE, SUITE 150 EMERYVILLE, CA 94608 |
X |
Christina Lui, Attorney-in-fact for Robert Kagle | 05/08/2009 | |
**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) | Of the 20,000 options, 5,000 options will vest on each of 8/8/2009, 11/8/2009, 2/8/2010 and 5/8/2010 or the date of Jamba Inc.'s 2010 Annual Meeting of Stockholders. |
(2) | Includes 79,160 shares of Common Stock issuable upon the conversion of warrants held by Mr. Kagle, 101,212 shares of Common Stock issuable upon exercise of options held by Mr. Kagle, 11,832 shares of Common Stock issuable upon the conversion of warrants held directly by Benchmark Capital Partners, L.P. ("BCP"), 1,444 shares of Common Stock issuable upon the conversion of warrants held by Benchmark Founder's Fund ("BFF"), 79,160 shares of Common Stock issuable upon the conversion of warrants held directly by Technology Venture Investors-IV L.P., as nominee for Technology Venture Investors-4, L.P., TVI Partners-4, L.P. and TVI Affiliates-4, L.P. ("TVI"). Mr. Kagle is a member or managing member of each entity that serves as the generalpartner to BCP IV, BCP, BFF and TVI, and Mr. Kagle may be deemed to have shared power to vote shares issuable upon conversion of such derivative securities, all of to which he disclaims beneficial ownership. |