Initial Statement of Beneficial Ownership (3)
June 18 2015 - 6:39PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
hours per response...
0.5
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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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1. Name and Address of Reporting Person
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Lytikainen Kimberly Gail
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2. Date of Event Requiring Statement (MM/DD/YYYY)
6/18/2015
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3. Issuer Name
and
Ticker or Trading Symbol
MINDBODY, Inc. [MB]
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(Last)
(First)
(Middle)
4051 BROAD STREET, SUITE 220
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
SVP, Gen. Counsel & Secretary /
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(Street)
SAN LUIS OBISPO, CA 93401
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Employee Stock Option (right to buy)
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(1)
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9/20/2024
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Common Stock
(2)
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162500
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$10.616
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D
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Employee Stock Option (right to buy)
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(3)
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2/5/2025
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Common Stock
(2)
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12500
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$14.476
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D
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Employee Stock Option (right to buy)
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(4)
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5/22/2025
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Common Stock
(2)
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75000
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$14.496
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D
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Explanation of Responses:
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(
1)
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25% of the shares subject to the option vest on July 7, 2015, and 2.0833% of the shares vest monthly thereafter.
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(
2)
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Each share of Common Stock shall be reclassified into one share of Class B Common Stock immediately prior to the completion of the Issuer's initial public offering of Class A Common Stock.
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(
3)
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1/48 of the shares subject to the option vested on March 5, 2015, and 1/48 of the shares vest monthly thereafter.
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(
4)
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1/48 of the shares subject to the option vest on June 22, 2015, and 1/48 of the shares vest monthly thereafter.
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Remarks:
Exhibit 24 - Power of Attorney
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Lytikainen Kimberly Gail
4051 BROAD STREET
SUITE 220
SAN LUIS OBISPO, CA 93401
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SVP, Gen. Counsel & Secretary
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Signatures
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/s/ Kimberly G. Lytikainen
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6/18/2015
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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