SEC FORM 4/A 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*
SORENSON CAPITAL PARTNERS III, LP

(Last) (First) (Middle)
3400 ASHTON BOULEVARD, #400

(Street)
LEHI UT 84043

(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)
07/26/2021
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 3,248,392 A (1) 3,406,128 I By: SCP Couchbase Acquisition, 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 F Preferred Stock (1) 07/26/2021 C 2,156,007 (1) (1) Common Stock 2,156,007 $0.00 0 I By: SCP Couchbase Acquisition, L.L.C.(2)(3)
Series G Preferred Stock (1) 07/26/2021 C 1,024,048 (1) (1) Common Stock 1,092,385 $0.00 0 I By: SCP Couchbase Acquisition, L.L.C.(2)(3)
1. Name and Address of Reporting Person*
SORENSON CAPITAL PARTNERS III, LP

(Last) (First) (Middle)
3400 ASHTON BOULEVARD, #400

(Street)
LEHI UT 84043

(City) (State) (Zip)
1. Name and Address of Reporting Person*
SORENSON CAPITAL PARTNERS III-A, LP

(Last) (First) (Middle)
3400 ASHTON BOULEVARD, #400

(Street)
LEHI UT 84043

(City) (State) (Zip)
1. Name and Address of Reporting Person*
SORENSON CAPITAL PARTNERS III-B, LP

(Last) (First) (Middle)
3400 ASHTON BOULEVARD, #400

(Street)
LEHI UT 84043

(City) (State) (Zip)
1. Name and Address of Reporting Person*
SORENSON CAPITAL INVESTMENT PARTNERS III, LP

(Last) (First) (Middle)
3400 ASHTON BOULEVARD, #400

(Street)
LEHI UT 84043

(City) (State) (Zip)
1. Name and Address of Reporting Person*
SORENSON CAPITAL ASSOCIATES III, LP

(Last) (First) (Middle)
3400 ASHTON BOULEVARD, #400

(Street)
LEHI UT 84043

(City) (State) (Zip)
1. Name and Address of Reporting Person*
WEST RIM CAPITAL ADVISORS LP

(Last) (First) (Middle)
3400 ASHTON BOULEVARD, #400

(Street)
LEHI UT 84043

(City) (State) (Zip)
1. Name and Address of Reporting Person*
WEST RIM CAPITAL ADVISORS LLC

(Last) (First) (Middle)
3400 ASHTON BOULEVARD, #400

(Street)
LEHI UT 84043

(City) (State) (Zip)
1. Name and Address of Reporting Person*
SCP COUCHBASE ACQUISITION L.L.C.

(Last) (First) (Middle)
3400 ASHTON BOULEVARD, #400

(Street)
LEHI UT 84043

(City) (State) (Zip)
Explanation of Responses:
1. Immediately prior to the completion of the Issuer's initial public offering, each share of 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 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. Sorenson Capital Partners III, LP ("SCP III"), Sorenson Capital Partners III-A, LP ("SCP III-A"), Sorenson Capital Partners III-B, LP ("SCP III-B") and Sorensen Capital Investment Partner III, LP ("SCIP III") are the members of SCP Couchbase Acquisition L.L.C. Sorenson Capital Associates III, LP ("SCA III") is the general partner of each of SCP III, SCP III-A and SCP III-B. West Rim Capital Advisors, LP ("West Rim Capital LP") is the general partner of SCIP III. West Rim Capital Advisors, LLC ("West Rim Capital") is the general partner of each of SCA III and West Rim Capital LP. Rob Rueckert is a member of the Issuer's board of directors and the president of SCP Couchbase Acquisition, L.L.C. Each of Mark Ludwig, Ron Mika, Rob Rueckert and Luke Sorenson are partners of West Rim Capital and therefore may be deemed to have shared voting and dispositive power with respect to the shares held by SCP Couchbase Acquisition L.L.C.
3. (continuation of FN 2): Each of the foregoing entities and individuals disclaim beneficial ownership of such shares except to the extent of their pecuniary interest therein. The address for each of the Sorenson entities listed above is 3400 Ashton Boulevard #400, Lehi, Utah 84043.
Remarks:
On July 26, 2021, SCP III, SCP III-A and SCP III-B filed a Form 4 (the "Original Form 4") with respect to shares of Common Stock, Series F Preferred Stock and Series G Preferred Stock held by SCP Couchbase Acquisition L.L.C., of which SCP III, SCP III-A, SCP III-B and SCIP III are members and for which Rob Rueckert serves as president. The purpose of this amendment is solely to ensure that the Central Index Keys for SCIP III, SCA III, West Rim Capital LP, West Rim Capital and SCP Couchbase Acquisition L.L.C. are included with respect to the Original Form 4 filing. No substantial amendments are being made to the contents of the Original Form 4.
Sorenson Capital Partners III, LP, /s/ Rob Rueckert, Authorized Signatory 08/11/2021
Sorenson Capital Partners III-A, LP, /s/ Rob Rueckert, Authorized Signatory 08/11/2021
Sorenson Capital Partners III-B, LP, /s/ Rob Rueckert, Authorized Signatory 08/11/2021
Sorenson Capital Investment Partners III, LP, /s/ Rob Rueckert, Authorized Signatory 08/11/2021
Sorenson Capital Associates III, LP, /s/ Rob Rueckert, Authorized Signatory 08/11/2021
West Rim Capital Advisors, LP, /s/ Rob Rueckert, Authorized Signatory 08/11/2021
West Rim Capital Advisors, LLC, /s/ Rob Rueckert, Authorized Signatory 08/11/2021
SCP Couchbase Acquisition L.L.C., /s/ Rob Rueckert, Authorized Signatory 08/11/2021
** Signature of Reporting Person Date
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