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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 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 | ||||||||
Class B Common Stock | (1) | 04/11/2022 | C | 1,048,005 | (1) | (1) | Class A Common Stock | 1,048,005 | $ 0 | 27,376,938 (3) | D | ||||
Class B Common Stock | (1) | (1) | (1) | Class A Common Stock | 8,129,863 | 8,129,863 | I | See footnote (4) | |||||||
Class B Common Stock | (1) | (1) | (1) | Class A Common Stock | 13,106,677 | 13,106,677 | I | See footnote (5) | |||||||
Class B Common Stock | (1) | (1) | (1) | Class A Common Stock | 2,791,081 | 2,791,081 (3) | I | See footnote (6) | |||||||
Class B Common Stock | (1) | (1) | (1) | Class A Common Stock | 500,000 | 500,000 | I | See footnote (7) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Thomas Ragy C/O SPRINKLR, INC. 29 WEST 35TH STREET, 7TH FLOOR NEW YORK, NY 10001 |
X | Chief Executive Officer |
/s/ Jason Minio, Attorney-in-Fact | 04/13/2022 | |
**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 B Common Stock is convertible at any time at the option of the Reporting Person into one share of Class A Common Stock. Each share of Class B Common Stock will convert automatically into shares of Class A common stock, on a one-to-one basis, upon the following: (1) the sale or transfer of such share of Class B Common Stock, subject to certain exceptions specified in the Issuer's amended and restated certificate of incorporation; (2) the death of the Reporting Person; and (3) the final conversion date, defined as the first trading day on or after the date on which the outstanding shares of Class B Common Stock represent less than 5.0% of the Issuer's then-outstanding Class A and Class B Common Stock to certain timing criteria. If the Reporting Person is terminated for cause, each share of Class B common stock will automatically convert to Class A Common Stock. |
(2) | The shares are being sold pursuant to a stock purchase agreement entered into as of April 11, 2022 relating to the purchase and sale of shares of Class B common stock of the Issuer. Pursuant to the Issuer's certificate of incorporation, each such share of Class B common stock of the Issuer will automatically convert into one share of Class A common stock when transferred in such transaction. Under the stock purchase agreement, there are limited conditions to the closing, which, if satisfied, will occur on a date to be mutually agreed by the parties thereto. |
(3) | 374,239 shares were transferred from the RT 2019 Grantor Retained Annuity Trust to the Reporting Person. This represents the number of shares held after the transfer. The transfer was a change in the form of beneficial ownership and was exempt from reporting pursuant to Rule 16a-13. |
(4) | The securities are held by Thomas 2014 Family Trust (the "2014 Trust"). The Reporting Person is a trustee of the 2014 Trust. |
(5) | The securities are held by Thomas Family 2017 Irrevocable Trust (the "2017 Trust"). The Reporting Person is a trustee of the 2017 Trust. |
(6) | The securities are held by RT 2019 Grantor Retained Annuity Trust (the "2019 Trust"). The Reporting Person is a trustee of the 2019 Trust. |
(7) | The securities are held by Neelu Paul, Trustee of the RT 2021 Grantor Retained Annuity Trust, dated June 8, 2021 (the "2021 Trust"). The Reporting Person is a trustee of the 2021 Trust. |