SEC FORM
3
SEC Form 3
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
INITIAL STATEMENT OF 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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OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 09/21/2020
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3. Issuer Name and Ticker or Trading Symbol
Asana, Inc.
[ ASAN ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Form filed by One Reporting Person |
X |
Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
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 Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
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: 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 |
Expiration Date |
Title |
Amount or Number of Shares |
Series A Preferred Stock |
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Existing Class B Common Stock
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13,461,600 |
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I |
See footnote
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Series B Preferred Stock |
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Existing Class B Common Stock
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184,642 |
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I |
See footnote
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Series E Preferred Stock |
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Existing Class B Common Stock
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366,461 |
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I |
See footnote
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
Remarks: |
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/s/ Steven M. Spurlock, as Managing Member of Benchmark Capital Management Co. VI, L.L.C. |
09/21/2020 |
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/s/ Steven M. Spurlock, as Managing Member of Benchmark Capital Management Co. VI, L.L.C., the General Partner of Benchmark Capital Partners VI, L.P. |
09/21/2020 |
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/s/ Steven M. Spurlock, as Managing Member of Benchmark Capital Management Co. VI, L.L.C., the General Partner of Benchmark Founders' Fund VI, L.P. |
09/21/2020 |
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/s/ Steven M. Spurlock, as Managing Member of Benchmark Capital Management Co. VI, L.L.C., the General Partner of Benchmark Founders' Fund VI-B, L.P. |
09/21/2020 |
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** 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
5
(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. |
AGREEMENT TO FILE JOINTLY AND STATEMENT APPOINTING DESIGNATED FILER AND
AUTHORIZED SIGNATORY
Each of the undersigned entities and individuals (collectively, the "Reporting
Persons") hereby authorizes and designates Benchmark Capital Management Co. VI,
L.L.C. or such other person or entity as is designated in writing by Steven M.
Spurlock (the "Designated Filer") as the beneficial owner to prepare and file on
behalf of such Reporting Person individually, or jointly together with the other
Reporting Persons, any and all reports, notices, communications and other
documents (including, but not limited to, reports on Schedule 13D, Schedule 13G,
Form 3, Form 4 and Form 5) that such Reporting Person may be required to file
with the United States Securities and Exchange Commission pursuant to the
Securities Act of 1933, as amended (together with the implementing regulations
thereto, the "Act"), the Securities Exchange Act of 1934, as amended (together
with the implementing regulations thereto, the "Exchange Act") or any other
state or federal agency (collectively, the "Reports") with respect to the
Reporting Person's ownership of, or transactions in, securities of any entity
whose securities are beneficially owned (directly or indirectly) by such
Reporting Person (collectively, the "Companies").
Each Reporting Person hereby further authorizes and designates Steven M.
Spurlock (the "Authorized Signatory") to execute and file on behalf of such
Reporting Person the Reports and to perform any and all other acts, which in the
opinion of the Designated Filer or Authorized Signatory may be necessary or
incidental to the performance of the foregoing powers herein granted.
The authority of the Designated Filer and the Authorized Signatory under this
Document with respect to each Reporting Person shall continue until such
Reporting Person is no longer required to file any Reports with respect to the
Reporting Person's ownership of, or transactions in, the securities of the
Companies, unless earlier revoked in writing. Each Reporting Person
acknowledges that the Designated Filer and the Authorized Signatory are not
assuming any of the Reporting Person's responsibilities to comply with the Act
or the Exchange Act.
March 21, 2013 BENCHMARK CAPITAL MANAGEMENT CO. VI, L.L.C.,
a Delaware Limited Liability Company
By: /s/ Steven M. Spurlock
Steven M. Spurlock, Managing Member
March 21, 2013 BENCHMARK CAPITAL PARTNERS VI, L.P.,
a Delaware Limited Partnership
By: Benchmark Capital Management Co. VI, L.L.C.,
a Delaware Limited Liability Company,
Its General Partner
By: /s/ Steven M. Spurlock
Steven M. Spurlock, Managing Member
March 21, 2013 BENCHMARK FOUNDERS' FUND VI, L.P.,
a Delaware Limited Partnership
By: Benchmark Capital Management Co. VI, L.L.C.,
a Delaware Limited Liability Company,
Its General Partner
By: /s/ Steven M. Spurlock
Steven M. Spurlock, Managing Member
March 21, 2013 BENCHMARK FOUNDERS' FUND VI-B, L.P.,
a Delaware Limited Partnership
By: Benchmark Capital Management Co. VI, L.L.C.,
a Delaware Limited Liability Company,
Its General Partner
By: /s/ Steven M. Spurlock
Steven M. Spurlock, Managing Member
March 21, 2013 By: /s/ Alexandre Balkanski
Alexandre Balkanski
March 21, 2013 By: /s/ Bruce W. Dunlevie
Bruce W. Dunlevie
March 21, 2013 By: /s/ J. William Gurley
J. William Gurley
March 21, 2013 By: /s/ Kevin R. Harvey
Kevin R. Harvey
March 21, 2013 By: /s/ Robert C. Kagle
Robert C. Kagle
March 21, 2013 By: /s/ Mitchell H. Lasky
Mitchell H. Lasky
March 21, 2013 By: /s/ Peter H. Fenton
Peter H. Fenton
March 21, 2013 By: /s/ Matthew R. Cohler
Matthew R. Cohler