SEC FORM 4 SEC Form 4
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
 
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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*
Accel X LP

(Last) (First) (Middle)
500 UNIVERSITY AVENUE

(Street)
PALO ALTO CA 94301

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Couchbase, Inc. [ BASE ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
07/26/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
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 07/26/2021 C 3,588,629 A (1) 3,852,959 D(2)(3)
Common Stock 07/26/2021 C 271,940 A (1) 291,963 I By: Accel X Strategic Partners L.P.(2)(3)
Common Stock 07/26/2021 C 1,682,587 A (1) 2,022,312 I By: Accel Growth Fund II L.P.(2)(3)
Common Stock 07/26/2021 C 121,884 A (1) 146,484 I By: Accel Growth Fund II Strategic Partners L.P.(2)(3)
Common Stock 07/26/2021 C 180,644 A (1) 217,110 I By: Accel Growth Fund Investors 2013 L.L.C.(2)(3)
Common Stock 07/26/2021 C 375,294 A (1) 402,927 I By: Accel Investors 2008 L.L.C.(2)(3)
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 A Preferred Stock (1) 07/26/2021 C 1,636,046 (1) (1) Common Stock 1,636,046 $0.00 0 D(2)(3)
Series A Preferred Stock (1) 07/26/2021 C 123,978 (1) (1) Common Stock 123,978 $0.00 0 I By: Accel X Strategic Partners L.P.(2)(3)
Series A Preferred Stock (1) 07/26/2021 C 171,097 (1) (1) Common Stock 171,097 $0.00 0 I By: Accel Investors 2008 L.L.C.(2)(3)
Series B Preferred Stock (1) 07/26/2021 C 874,690 (1) (1) Common Stock 874,690 $0.00 0 D(2)(3)
Series B Preferred Stock (1) 07/26/2021 C 66,283 (1) (1) Common Stock 66,283 $0.00 0 I By: Accel X Strategic Partners L.P.(2)(3)
Series B Preferred Stock (1) 07/26/2021 C 91,474 (1) (1) Common Stock 91,474 $0.00 0 I By: Accel Investors 2008 L.L.C.(2)(3)
Series C Preferred Stock (1) 07/26/2021 C 336,658 (1) (1) Common Stock 336,658 $0.00 0 D(2)(3)
Series C Preferred Stock (1) 07/26/2021 C 25,511 (1) (1) Common Stock 25,511 $0.00 0 I By: Accel X Strategic Partners L.P.(2)(3)
Series C Preferred Stock (1) 07/26/2021 C 35,207 (1) (1) Common Stock 35,207 $0.00 0 I By: Accel Investors 2008 L.L.C.(2)(3)
Series D Preferred Stock (1) 07/26/2021 C 279,944 (1) (1) Common Stock 279,944 $0.00 0 D(2)(3)
Series D Preferred Stock (1) 07/26/2021 C 21,214 (1) (1) Common Stock 21,214 $0.00 0 I By: Accel X Strategic Partners L.P.(2)(3)
Series D Preferred Stock (1) 07/26/2021 C 29,276 (1) (1) Common Stock 29,276 $0.00 0 I By: Accel Investors 2008 L.L.C.(2)(3)
Series E Preferred Stock (1) 07/26/2021 C 130,898 (1) (1) Common Stock 137,809 $0.00 0 D(2)(3)
Series E Preferred Stock (1) 07/26/2021 C 9,919 (1) (1) Common Stock 10,442 $0.00 0 I By: Accel X Strategic Partners L.P.(2)(3)
Series E Preferred Stock (1) 07/26/2021 C 1,083,886 (1) (1) Common Stock 1,141,113 $0.00 0 I By: Accel Growth Fund II L.P.(2)(3)
Series E Preferred Stock (1) 07/26/2021 C 78,516 (1) (1) Common Stock 82,661 $0.00 0 I By: Accel Growth Fund II Strategic Partners L.P.(2)(3)
Series E Preferred Stock (1) 07/26/2021 C 116,368 (1) (1) Common Stock 122,512 $0.00 0 I By: Accel Growth Fund Investors 2013 L.L.C.(2)(3)
Series E Preferred Stock (1) 07/26/2021 C 13,689 (1) (1) Common Stock 14,411 $0.00 0 I By: Accel Investors 2008 L.L.C.(2)(3)
Series F Preferred Stock (1) 07/26/2021 C 92,672 (1) (1) Common Stock 92,672 $0.00 0 D(2)(3)
Series F Preferred Stock (1) 07/26/2021 C 7,022 (1) (1) Common Stock 7,022 $0.00 0 I By: Accel X Strategic Partners L.P.(2)(3)
Series F Preferred Stock (1) 07/26/2021 C 155,124 (1) (1) Common Stock 155,124 $0.00 0 I By: Accel Growth Fund II L.P.(2)(3)
Series F Preferred Stock (1) 07/26/2021 C 11,237 (1) (1) Common Stock 11,237 $0.00 0 I By: Accel Growth Fund II Strategic Partners L.P.(2)(3)
Series F Preferred Stock (1) 07/26/2021 C 16,654 (1) (1) Common Stock 16,654 $0.00 0 I By: Accel Growth Fund Investors 2013 L.L.C.(2)(3)
Series F Preferred Stock (1) 07/26/2021 C 9,691 (1) (1) Common Stock 9,691 $0.00 0 I By: Accel Investors 2008 L.L.C.(2)(3)
Series G Preferred Stock (1) 07/26/2021 C 216,371 (1) (1) Common Stock 230,810 $0.00 0 D(2)(3)
Series G Preferred Stock (1) 07/26/2021 C 16,396 (1) (1) Common Stock 17,490 $0.00 0 I By: Accel X Strategic Partners L.P.(2)(3)
Series G Preferred Stock (1) 07/26/2021 C 362,181 (1) (1) Common Stock 386,350 $0.00 0 I By: Accel Growth Fund II L.P.(2)(3)
Series G Preferred Stock (1) 07/26/2021 C 26,236 (1) (1) Common Stock 27,986 $0.00 0 I By: Accel Growth Fund II Strategic Partners L.P.(2)(3)
Series G Preferred Stock (1) 07/26/2021 C 38,884 (1) (1) Common Stock 41,478 $0.00 0 I By: Accel Growth Fund Investors 2013 L.L.C.(2)(3)
Series G Preferred Stock (1) 07/26/2021 C 22,628 (1) (1) Common Stock 24,138 $0.00 0 I By: Accel Investors 2008 L.L.C.(2)(3)
1. Name and Address of Reporting Person*
Accel X LP

(Last) (First) (Middle)
500 UNIVERSITY AVENUE

(Street)
PALO ALTO CA 94301

(City) (State) (Zip)
1. Name and Address of Reporting Person*
ACCEL X STRATEGIC PARTNERS LP

(Last) (First) (Middle)
500 UNIVERSITY AVENUE

(Street)
PALO ALTO CA 94301

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Accel X Associates L.L.C.

(Last) (First) (Middle)
500 UNIVERSITY AVENUE

(Street)
PALO ALTO CA 94301

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Accel Investors 2008 L.L.C.

(Last) (First) (Middle)
500 UNIVERSITY AVENUE

(Street)
PALO ALTO CA 94301

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Accel Growth Fund II L.P.

(Last) (First) (Middle)
500 UNIVERSITY AVENUE

(Street)
PALO ALTO CA 94301

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Accel Growth Fund II Strategic Partners L.P.

(Last) (First) (Middle)
500 UNIVERSITY AVENUE

(Street)
PALO ALTO CA 94301

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Accel Growth Fund II Associates L.L.C.

(Last) (First) (Middle)
500 UNIVERSITY AVENUE

(Street)
PALO ALTO CA 94301

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Accel Growth Fund Investors 2013 L.L.C.

(Last) (First) (Middle)
500 UNIVERSITY AVENUE

(Street)
PALO ALTO CA 94301

(City) (State) (Zip)
Explanation of Responses:
1. Immediately prior to the completion of the Issuer's initial public offering, each share of Series A Preferred Stock, Series B Preferred Stock, Series C Preferred Stock, Series D Preferred Stock and Series F Preferred Stock is convertible into shares of the Issuer's Common Stock, par value $0.00001 per share, on a one-for-one basis and has no expiration date. Immediately prior to the completion of the Issuer's initial public offering, each share of Series E Preferred Stock is convertible into shares of the Issuer's Common Stock, par value $0.00001 per share, on a 1.05279880234039-for-one basis and has no expiration date. Immediately prior to the completion of the Issuer's initial public offering, each share of Series G Preferred Stock is convertible into shares of the Issuer's Common Stock, par value $0.00001 per share, on a 1.06673317089756-for-one basis and has no expiration date.
2. Kevin J. Efrusy is a Managing Member of Accel X Associates L.L.C., or A10A, which is the General Partner of both Accel X L.P. and Accel X Strategic Partners L.P., and has the sole voting and investment power. Andrew G. Braccia, Kevin J. Efrusy, Sameer K. Gandhi, Ping Li, Tracy L. Sedlock and Richard P. Wong are the Managing Members of Accel Investors 2008 L.L.C., and therefore share the voting and investment powers. Accel Growth Fund II Associates L.L.C., or AGF2A, is the General Partner of both Accel Growth Fund II L.P. and Accel Growth Fund II Strategic Partners L.P., and has the sole voting and investment power. Andrew G. Braccia, Sameer K. Gandhi, Ping Li, Tracy L. Sedlock, Ryan J. Sweeney and Richard P. Wong are the Managing Members of AGF2A and share such powers. Andrew G. Braccia, Sameer K. Gandhi, Ping Li, Tracy L. Sedlock, Ryan J. Sweeney and Richard P. Wong are the Managing Members of Accel Growth Fund Investors 2013 L.L.C.,
3. (continuation of FN 2): and therefore share the voting and investment powers. Each general partner or manager disclaims beneficial ownership except to the extent of their pecuniary interest therein. The address for all Accel entities listed above is 500 University Avenue, Palo Alto, California 94301.
Remarks:
/s/ Tracy L. Sedlock, as Attorney in Fact for Accel X L.P. 07/26/2021
/s/ Tracy L. Sedlock, as Attorney in Fact for Accel X Strategic Partners L.P. 07/26/2021
/s/ Tracy L. Sedlock, as Attorney in Fact for Accel X Associates L.L.C. 07/26/2021
/s/ Tracy L. Sedlock, as Attorney in Fact for Accel Investors 2008 L.L.C. 07/26/2021
/s/ Tracy L. Sedlock, as Attorney in Fact for Accel Growth Fund II L.P. 07/26/2021
/s/ Tracy L. Sedlock, as Attorney in Fact for Accel Growth Fund II Strategic Partners L.P. 07/26/2021
/s/ Tracy L. Sedlock, as Attorney in Fact for Accel Growth Fund II Associates L.L.C. 07/26/2021
/s/ Tracy L. Sedlock, as Attorney in Fact for Accel Growth Fund Investors 2013 L.L.C. 07/26/2021
** Signature of Reporting Person Date
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