SEC Filing | Five9, Inc.

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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^*

Mosaic Venture Partners II Limited Partnership

(Last)

(First)

(Middle)

6300 NORTHAM DRIVE

(Street)

MISSISSAUGA, ONTARIO

L4V 1H7

(City)

(State)

(Zip)

2. Issuer Name and Ticker or Trading Symbol
Five9, Inc. [ FIVN ]

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)
10/29/2014

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)
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
Common Stock	10/29/2014		J		6,307,484	D	$0.00	0	D⁽¹⁾

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)
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)	Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	8. Price of Derivative Security (Instr. 5)		10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)

1. Name and Address of Reporting Person^*

Mosaic Venture Partners II Limited Partnership

(Last)

(First)

(Middle)

6300 NORTHAM DRIVE

(Street)

MISSISSAUGA, ONTARIO

L4V 1H7

(City)

(State)

(Zip)

1. Name and Address of Reporting Person^*

Samuel David G.

(Last)

(First)

(Middle)

C/O BIRCH HILL EQUITY PARTNERS 100

WELLINGTON ST, W. SUITE 2300, PO BOX 22

(Street)

TORONTO, ONTARIO

M5K 1A1

(City)

(State)

(Zip)

1. Name and Address of Reporting Person^*

1369904 Ontario, Inc.

(Last)

(First)

(Middle)

C/O MOSAIC VENTURE PARTNERS II, L.P.

6300 NORTHAM DRIVE

(Street)

MISSISSAUGA, ONTARIO

L4V 1H7

(City)

(State)

(Zip)

1. Name and Address of Reporting Person^*

Lobo Vernon F

(Last)

(First)

(Middle)

C/O MOSAIC VENTURE PARTNERS II, L.P.

6300 NORTHAM DRIVE

(Street)

MISSISSAUGA, ONTARIO

L4V 1H7

(City)

(State)

(Zip)

Explanation of Responses:

1. Mosaic Venture Partners II, Limited Partnership ("Mosaic") was the record owner of these shares. 1369904 Ontario, Inc. ("Ontario"), as the general partner of Mosaic, had voting and investment control of the shares held by Mosaic. David Samuel and Vernon Lobo are Managing Directors of Ontario and may have been deemed to share voting and investment power with respect to the shares held by Mosaic. Mr. Samuel and Mr. Lobo disclaimed beneficial ownership of all shares held by Mosaic except to the extent of their pecuniary interest therein.

Remarks:

Five9, Inc. shares were distributed out to various partners by Mosaic Venture Partners II Limited Partnership

	/s/ Vernon Lobo, authorized signatory of 1369904 Ontario Inc., the general partner of the Reporting Person	10/31/2014
	/s/ Frances Dea, attorney-in-fact	10/31/2014
	/s/ Vernon Lobo, authorized signatory of the Reporting Owner	10/31/2014
	/s/ Vernon Lobo	10/31/2014
	** 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 4 (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).
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