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 |
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*
11 HAMENOFIM STREET, BUILDING B |
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(Street)
| 2. Date of Event Requiring Statement
(Month/Day/Year) 10/26/17 | 3. Issuer Name and Ticker or Trading Symbol
FORESCOUT TECHNOLOGIES, INC
[ FSCT ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| Director | X | 10% Owner |
| Officer (give title below) |
| 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)
| 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)
| 2.
Amount of Securities Beneficially Owned (Instr.
4)
| 3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
| 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) |
1. Title of Derivative Security (Instr.
4)
| 2. Date Exercisable and Expiration Date
(Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
| 4. Conversion or Exercise Price of Derivative Security
| 5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
| 6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Series F Convertible Preferred Stock | | | Common Stock | 200,927 | | I | See footnote |
Series F Convertible Preferred Stock | | | Common Stock | 18,574 | | I | See footnote |
Series F Convertible Preferred Stock | | | Common Stock | 54,330 | | I | See footnote |
Series F Convertible Preferred Stock | | | Common Stock | 7,072 | | I | See footnote |
Series F Convertible Preferred Stock | | | Common Stock | 29,235 | | I | See footnote |
Series F Convertible Preferred Stock | | | Common Stock | 14,145 | | I | See footntoe |
1. Name and Address of Reporting Person*
11 HAMENOFIM STREET, BUILDING B |
|
(Street)
|
1. Name and Address of Reporting Person*
11 HAMENOFIM STREET, BUILDING B |
|
(Street)
|
1. Name and Address of Reporting Person*
11 HAMENOFIM STREET, BUILDING B |
|
(Street)
|
1. Name and Address of Reporting Person*
11 HAMENOFIM STREET, BUILDING B |
|
(Street)
|
1. Name and Address of Reporting Person*
11 HAMENOFIM STREET, BUILDING B |
|
(Street)
|
1. Name and Address of Reporting Person*
11 HAMENOFIM STREET, BUILDING B |
|
(Street)
|
1. Name and Address of Reporting Person*
11 HAMENOFIM STREET, BUILDING B |
|
(Street)
|
Explanation of Responses: |
Remarks: | |
| /s/ Rami Kalish, /s/ Rami Beracha, Managing General Partners, Pitango V.C. Fund III General Partner | 10/26/17 |
| /s/ Rami Kalish, /s/ Rami Beracha, Managing General Partners, Pitango V.C. Fund III General Partner, the general partner of Pitango Venture Capital Fund III (USA) L.P. | 10/26/17 |
| /s/ Rami Kalish, /s/ Rami Beracha, Managing General Partners, Pitango V.C. Fund III General Partner, the general partner of Pitango Venture Capital Fund III (USA) Non-Q L.P. | 10/26/17 |
| /s/ Rami Kalish, /s/ Rami Beracha, Managing General Partners, Pitango V.C. Fund III General Partner, the general partner of Pitango Venture Capital Fund III (Israeli Investors) L.P. | 10/26/17 |
| /s/ Rami Kalish, /s/ Rami Beracha, Managing General Partners, Pitango V.C. Fund III General Partner, the general partner of Pitango Principals Fund III (USA) L.P. | 10/26/17 |
| /s/ Rami Kalish, /s/ Rami Beracha, Managing General Partners, Pitango V.C. Fund III General Partner, the general partner of Pitango Parallel Investor Fund III (USA) L.P. | 10/26/17 |
| /s/ Rami Kalish, /s/ Rami Beracha, Managing General Partners, Pitango V.C. Fund III General Partner, the general partner of Pitango Venture Capital Fund III Trusts 2000 Ltd | 10/26/17 |
| ** 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. |
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