View:
| FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
|
|||||||||||||||
 |
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | ||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
|
2. Issuer Name and Ticker or Trading Symbol
Health Catalyst, Inc. [ HCAT ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
||||||||||||||||||||||||
|
3. Date of Earliest Transaction
(Month/Day/Year) 07/29/2019 | ||||||||||||||||||||||||||
|
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
|
|||||||||||||||||||||||||
| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Code | V | Amount | (A) or (D) | Price | ||||||
| Common Stock(1) | 07/29/2019 | C | 2,952,091 | A | (2)(3)(4)(5)(6) | 2,952,091 | D | |||
| Common Stock | 07/29/2019 | C | 2,952,090 | A | (2)(3)(4)(5)(6) | 2,952,090 | I | By Limited Partnership(7) | ||
|
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Series B Convertible Preferred Stock(1) | (2) | 07/29/2019 | C | 1,442,727 | (2) | (2) | Common Stock | 1,442,727 | $0.00 | 0 | D | ||||
| Series C Convertible Preferred Stock(1) | (3) | 07/29/2019 | C | 577,045 | (3) | (3) | Common Stock | 577,045 | $0.00 | 0 | D | ||||
| Series D Convertible Preferred Stock(1) | (4) | 07/29/2019 | C | 471,832 | (4) | (4) | Common Stock | 471,832 | $0.00 | 0 | D | ||||
| Series E Convertible Preferred Stock(1) | (5) | 07/29/2019 | C | 424,568 | (5) | (5) | Common Stock | 424,568 | $0.00 | 0 | D | ||||
| Series F Convertible Preferred Stock(1) | (6) | 07/29/2019 | C | 35,919 | (6) | (6) | Common Stock | 35,919 | $0.00 | 0 | D | ||||
| Series B Convertible Preferred Stock | (2) | 07/29/2019 | C | 1,442,727 | (2) | (2) | Common Stock | 1,442,727 | $0.00 | 0 | I | By Limited Partnership(7) | |||
| Series C Convertible Preferred Stock | (3) | 07/29/2019 | C | 577,045 | (3) | (3) | Common Stock | 577,045 | $0.00 | 0 | I | By Limited Partnership(7) | |||
| Series D Convertible Preferred Stock | (4) | 07/29/2019 | C | 471,831 | (4) | (4) | Common Stock | 471,831 | $0.00 | 0 | I | By Limited Partnership(7) | |||
| Series E Convertible Preferred Stock | (5) | 07/29/2019 | C | 424,568 | (5) | (5) | Common Stock | 424,568 | $0.00 | 0 | I | By Limited Partnership(7) | |||
| Series F Convertible Preferred Stock | (6) | 07/29/2019 | C | 35,919 | (6) | (6) | Common Stock | 35,919 | $0.00 | 0 | I | By Limited Partnership(7) | |||
1. Name and Address of Reporting Person*
(Street)
| ||||||||||||
1. Name and Address of Reporting Person*
(Street)
| ||||||||||||
1. Name and Address of Reporting Person*
(Street)
| ||||||||||||
1. Name and Address of Reporting Person*
(Street)
|
| Explanation of Responses: |
| 1. The securities shown on Line 1 of Table I and Lines 1 through 5 of Table II represent securities held of record by Norwest Venture Partners XI, LP ("NVP XI"). Genesis VC Partners XI, LLC ("Genesis XI") is the general partner of NVP XI and may be deemed to have sole voting and dispositive power over the shares held by NVP XI. NVP Associates, LLC ("NVP Associates"), the managing member of Genesis XI, and Jeffrey Crowe and Jon E. Kossow, as Co-Chief Executive Officers of NVP Associates, may be deemed to share voting and dispositive power with respect to such securities. Such entities, Crowe and Kossow disclaim beneficial ownership of all such securities, except to the extent of any pecuniary interest therein. |
| 2. The Series B Convertible Preferred Stock automatically converted into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of Common Stock and has no expiration date. |
| 3. The Series C Convertible Preferred Stock automatically converted into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of Common Stock and has no expiration date. |
| 4. The Series D Convertible Preferred Stock automatically converted into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of Common Stock and has no expiration date. |
| 5. The Series E Convertible Preferred Stock automatically converted into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of Common Stock and has no expiration date. |
| 6. The Series F Convertible Preferred Stock automatically converted into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of Common Stock and has no expiration date. |
| 7. The securities shown on Line 2 of Table I and Lines 6 through 10 of Table II represent securities held of record by Norwest Venture Partners XII, LP ("NVP XII"). Genesis VC Partners XII, LLC ("Genesis XII") is the general partner of NVP XII and may be deemed to have sole voting and dispositive power over the shares held by NVP XII. NVP Associates, LLC ("NVP Associates"), the managing member of Genesis XII, and Jeffrey Crowe and Jon E. Kossow, as Co-Chief Executive Officers of NVP Associates, may be deemed to share voting and dispositive power with respect to such securities. Such entities, Crowe and Kossow disclaim beneficial ownership of all such securities, except to the extent of any pecuniary interest therein. |
| Remarks: |
| /s/ Matthew De Dominicis, Chief Financial Officer | 07/29/2019 | |
| ** 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 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). | ||
| 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. | ||