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*
Welsh David S.

(Last) (First) (Middle)
C/O ADAMS STREET PARTNERS LLC
ONE NORTH WACKER DRIVE SUITE 2200

(Street)
CHICAGO IL 60606

(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)
X Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
05/16/2016
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
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 05/16/2016 J(1) 42,840 A $0.00 42,840 D
Common Stock 67,173 D(2)
Common Stock 2,584,821 I See Footnote(3)
Common Stock 2,235,689 I See Footnote(4)
Common Stock 1,269,991 I See Footnote(5)
Common Stock 1,084,176 I See Footnote(6)
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
Explanation of Responses:
1. Distribution from funds managed by Partech International, LLC, of which the reporting person was formerly a partner.
2. The reported shares are owned directly by David Welsh, who is a partner of Adams Street Partners, LLC ("ASP"). ASP is the managing member of the general partner of Adams Street 2008 Direct Fund, LP ("AS 2008"), Adams Street 2009 Direct Fund, LP ("AS 2009"), Adams Street 2010 Direct Fund, LP ("AS 2010") and the managing member of the general partner of the general partner of Adams Street 2011 Direct Fund LP ("AS 2011") (such funds collectively, the "Funds"). By agreement with the Funds, Mr. Welsh is deemed to hold the shares for the benefit of the Funds. Mr. Welsh disclaims beneficial ownership of the shares except to the extent of his pecuniary interest therein.
3. The reported securities are owned directly by AS 2008 (the "Shares") and indirectly by ASP as the managing member of the general partner of AS 2008. The securities owned by AS 2008 may be deemed to be beneficially owned by ASP and David S. Welsh, who is a partner of ASP, and may be deemed to have shared voting and investment power over the shares. Mr. Welsh disclaims beneficial ownership of the Shares except to the extent of his pecuniary interest therein.
4. The reported securities are owned directly by AS 2009 (the "Shares") and indirectly by ASP as the managing member of the general partner of AS 2009. The securities owned by AS 2009 may be deemed to be beneficially owned by ASP and David S. Welsh, who is a partner of ASP, and may be deemed to have shared voting and investment power over the shares. Mr. Welsh disclaims beneficial ownership of the Shares except to the extent of his pecuniary interest therein.
5. The reported securities are owned directly by AS 2010 (the "Shares") and indirectly by ASP as the managing member of the general partner of AS 2010. The securities owned by AS 2010 may be deemed to be beneficially owned by ASP and David S. Welsh, who is a partner of ASP, and may be deemed to have shared voting and investment power over the shares. Mr. Welsh disclaims beneficial ownership of the Shares except to the extent of his pecuniary interest therein.
6. The reported securities are owned directly by AS 2011 (the "Shares") and indirectly by ASP as the managing member of the general partner of AS 2011. The securities owned by AS 2011 may be deemed to be beneficially owned by ASP and David S. Welsh, who is a partner of ASP, and may be deemed to have shared voting and investment power over the shares. Mr. Welsh disclaims beneficial ownership of the Shares except to the extent of his pecuniary interest therein.
Remarks:
/s/ Barry Zwarenstein, attorney-in-fact 06/16/2016
** 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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