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*
Partech U.S. Partners IV, L.L.C.

(Last) (First) (Middle)
200 CALIFORNIA ST., STE 500

(Street)
SAN FRANCISCO CA 94111

(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)
12/02/2015
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 3,510,983 D
Common Stock 12/02/2015 J 678,128 D $0.00 0 I By Partech International Growth Capital I L.L.C.(1)(2)(3)
Common Stock 12/02/2015 J 1,117,124 D $0.00 0 I By Partech International Growth Capital II L.L.C.(1)(2)(3)
Common Stock 12/02/2015 J 678,130 D $0.00 0 I By Partech International Growth Capital III L.L.C.(1)(2)(3)
Common Stock 12/02/2015 J 276,103 D $0.00 0 I By AXA Growth Capital II L.P.(1)(2)(3)
Common Stock 24,580 I By 45th Parallel L.L.C.(1)(2)(3)
Common Stock 24,580 I By Par SF II, L.L.C.(1)(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
1. Name and Address of Reporting Person*
Partech U.S. Partners IV, L.L.C.

(Last) (First) (Middle)
200 CALIFORNIA ST., STE 500

(Street)
SAN FRANCISCO CA 94111

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Partech International Growth Capital I LLC

(Last) (First) (Middle)
200 CALIFORNIA ST., STE 500

(Street)
SAN FRANCISCO CA 94111

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Partech International Growth Capital II LLC

(Last) (First) (Middle)
200 CALIFORNIA ST., STE 500

(Street)
SAN FRANCISCO CA 94111

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Partech International Growth Capital III LLC

(Last) (First) (Middle)
200 CALIFORNIA ST., STE 500

(Street)
SAN FRANCISCO CA 94111

(City) (State) (Zip)
1. Name and Address of Reporting Person*
AXA Growth Capital II LP

(Last) (First) (Middle)
200 CALIFORNIA ST., STE 500

(Street)
SAN FRANCISCO CA 94111

(City) (State) (Zip)
1. Name and Address of Reporting Person*
45th Parallel LLC

(Last) (First) (Middle)
200 CALIFORNIA ST., STE 500

(Street)
SAN FRANCISCO CA 94111

(City) (State) (Zip)
1. Name and Address of Reporting Person*
PAR SF II, L.L.C.

(Last) (First) (Middle)
200 CALIFORNIA ST., STE 500

(Street)
SAN FRANCISCO CA 94111

(City) (State) (Zip)
1. Name and Address of Reporting Person*
46th Parallel LLC

(Last) (First) (Middle)
200 CALIFORNIA ST., STE 500

(Street)
SAN FRANCISCO CA 94111

(City) (State) (Zip)
1. Name and Address of Reporting Person*
47th Parallel LLC

(Last) (First) (Middle)
200 CALIFORNIA ST., STE 500

(Street)
SAN FRANCISCO CA 94111

(City) (State) (Zip)
1. Name and Address of Reporting Person*
48th Parallel LLC

(Last) (First) (Middle)
200 CALIFORNIA ST., STE 500

(Street)
SAN FRANCISCO CA 94111

(City) (State) (Zip)
Explanation of Responses:
1. Vincent R. Worms is (A) the sole member of Par SF II L.L.C. ("Par SF"), (B) the managing member of 47th Parallel, L.L.C. ("47th Parallel"), which is the managing member of Partech U.S. Partners IV, L.L.C. ("Partech US"), (C) the managing member of 45th Parallel L.L.C. ("45th Parallel"), which is the managing member of 46th Parallel L.L.C. ("46th Parallel"), which is the managing member of Partech International Growth Capital I L.L.C. ("Partech I"), Partech International Growth Capital II L.L.C.("Partech II") and Partech International Growth Capital III L.L.C. ("Partech III")
2. (Continued from footnote1) and (D) the managing member of 48th Parallel L.L.C. ("48th Parallel"), which is the investment general partner of AXA Growth Capital II L.P. ("AXA").
3. Vincent R. Worms may be deemed to have voting control and investment power over the securities held by Par SF, Partech US, 45th Parallel, Partech I, Partech II, Partech III and AXA, but disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
Remarks:
Form 1 of 2 Five9, Inc. shares were distributed out to various partners by Partech I, Partech II, Partech III and AXA.
/s/ Vincent R. Worms, managing member of 47th Parallel, L.L.C., the managing member of the Reporting Person 12/04/2015
/s/ Vincent R. Worms, managing member of 45th Parallel, L.L.C., the managing member of 46th Parallel, L.L.C., the managing member of the Reporting Owner 12/04/2015
/s/ Vincent R. Worms, managing member of 45th Parallel, L.L.C., the managing member of 46th Parallel, L.L.C., the managing member of the Reporting Owner 12/04/2015
/s/ Vincent R. Worms, managing member of 45th Parallel, L.L.C., the managing member of 46th Parallel, L.L.C., the managing member of the Reporting Owner 12/04/2015
/s/ Vincent R. Worms, managing member of 48th Parallel, L.L.C., the Investment General Partner of the Reporting Owner 12/04/2015
/s/ Vincent R. Worms, managing member of the Reporting Owner 12/04/2015
/s/ Vincent R. Worms, sole member of the Reporting Owner 12/04/2015
/s/ Vincent R. Worms, managing member of 45th Parallel, L.L.C., the managing member of the Reporting Owner 12/04/2015
/s/ Vincent R. Worms, managing member of the Reporting Owner 12/04/2015
/s/ Vincent R. Worms, managing member of the Reporting Owner 12/04/2015
** Signature of Reporting Person Date
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* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
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