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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*
Fagnan Jeff

(Last) (First) (Middle)
C/O ACCOMPLICE
25 FIRST STREET, SUITE 303

(Street)
CAMBRIDGE MA 02141

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Carbon Black, Inc. [ CBLK ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
05/08/2018
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 05/08/2018 C 8,148,778 A (7) 9,365,231 I By Atlas Venture Fund VI, L.P.(1)
Common Stock 05/08/2018 C 249,193 A (7) 286,392 I By Atlas Venture Entrepreneurs' Fund VI, L.P.(2)
Common Stock 05/08/2018 C 149,207 A (7) 171,480 I By Atlas Venture Fund VI GmbH & Co. KG(3)
Common Stock 05/08/2018 C 181,273 A (7) 181,273 I By Atlas Venture Fund IX, L.P.(4)
Common Stock 05/08/2018 C 21,079 A (7) 21,079 I By Accom B9F Investors, LLC(5)
Common Stock 174,500 I By Accomplice CB Investors, LLC(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
Series B Convertible Preferred Stock (7) 05/08/2018 C 7,398,761 (7) (7) Common Stock 3,699,380 (7) 0 I By Atlas Venture Fund VI, L.P.(1)
Series B Convertible Preferred Stock (7) 05/08/2018 C 226,258 (7) (7) Common Stock 113,129 (7) 0 I By Atlas Venture Entrepreneurs' Fund VI, L.P.(2)
Series B Convertible Preferred Stock (7) 05/08/2018 C 135,475 (7) (7) Common Stock 67,737 (7) 0 I By Atlas Venture Fund VI GmbH & Co. KG(3)
Series C Convertible Preferred Stock (7) 05/08/2018 C 4,544,751 (7) (7) Common Stock 2,272,375 (7) 0 I By Atlas Venture Fund VI, L.P.(1)
Series C Convertible Preferred Stock (7) 05/08/2018 C 138,981 (7) (7) Common Stock 69,490 (7) 0 I By Atlas Venture Entrepreneurs' Fund VI, L.P.(2)
Series C Convertible Preferred Stock (7) 05/08/2018 C 83,217 (7) (7) Common Stock 41,608 (7) 0 I By Atlas Venture Fund VI GmbH & Co. KG(3)
Series D Convertible Preferred Stock (7) 05/08/2018 C 1,263,264 (7) (7) Common Stock 631,632 (7) 0 I By Atlas Venture Fund VI, L.P.(1)
Series D Convertible Preferred Stock (7) 05/08/2018 C 38,631 (7) (7) Common Stock 19,315 (7) 0 I By Atlas Venture Entrepreneurs' Fund VI, L.P.(2)
Series D Convertible Preferred Stock (7) 05/08/2018 C 23,131 (7) (7) Common Stock 11,565 (7) 0 I By Atlas Venture Fund VI GmbH & Co. KG(3)
Series E Convertible Preferred Stock (7) 05/08/2018 C 3,090,783 (7) (7) Common Stock 1,545,391 (7) 0 I By Atlas Venture Fund VI, L.P.(1)
Series E Convertible Preferred Stock (7) 05/08/2018 C 94,518 (7) (7) Common Stock 47,259 (7) 0 I By Atlas Venture Entrepreneurs' Fund VI, L.P.(2)
Series E Convertible Preferred Stock (7) 05/08/2018 C 56,594 (7) (7) Common Stock 28,297 (7) 0 I By Atlas Venture Fund VI GmbH & Co. KG(3)
Series E Convertible Preferred Stock (7) 05/08/2018 C 362,548 (7) (7) Common Stock 181,273 (7) 0 I By Atlas Venture Fund IX, L.P.(4)
Series F Convertible Preferred Stock (7) 05/08/2018 C 42,158 (7) (7) Common Stock 21,079 (7) 0 I By Accom B9F Investors, LLC(5)
Explanation of Responses:
1. The shares are held directly by Atlas Venture Fund VI, L.P. ("AVF VI"). Atlas Venture Associates VI, L.P. ("AVA VI LP") is the sole general partner of AVF VI. Atlas Venture Associates VI, Inc. ("AVA VI Inc.") is the sole general partner of AVA VI LP. Mr. Fagnan is a director of AVA VI Inc. and is an investor in a limited partner of AVF VI. Mr. Fagnan disclaims Section 16 beneficial ownership of all shares except to the extent of his pecuniary interest, if any, therein. This report shall not be deemed to be an admission that Mr. Fagnan is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
2. The shares are held directly by Atlas Venture Entrepreneurs' Fund VI, L.P. ("AVEF VI"). AVA VI LP is the sole general partner of AVEF VI. Mr. Fagnan disclaims Section 16 beneficial ownership of all shares except to the extent of his pecuniary interest, if any, therein. This report shall not be deemed to be an admission that Mr. Fagnan is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
3. The shares are held directly by Atlas Venture Fund VI GmbH & Co. KG ("AVFG VI"). AVA VI LP is the managing partner of AVFG VI. Mr. Fagnan disclaims Section 16 beneficial ownership of all shares except to the extent of his pecuniary interest, if any, therein. This report shall not be deemed to be an admission that Mr. Fagnan is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
4. The shares are held directly by Atlas Venture Fund IX, L.P. ("AVF IX"). Atlas Venture Associates IX, L.P. ("AVA IX LP") is the general partner of AVF IX. Atlas Venture Associates IX, LLC ("AVA IX LLC") is the general partner of AVA IX LP. Mr. Fagnan is a member of AVA IX LP. Mr. Fagnan disclaims Section 16 beneficial ownership of all shares except to the extent of his pecuniary interest, if any, therein. This report shall not be deemed to be an admission that Mr. Fagnan is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
5. The shares are held directly by Accom B9F Investors, LLC ("AB9F"). Mr. Fagnan is a member of AB9F. Mr. Fagnan disclaims Section 16 beneficial ownership of all shares except to the extent of his pecuniary interest, if any, therein. This report shall not be deemed to be an admission that Mr. Fagnan is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
6. The shares are held directly by Accomplice CB Investors LLC ("ACBI"). Mr. Fagnan is a member of ACBI. Mr. Fagnan disclaims Section 16 beneficial ownership of all shares except to the extent of his pecuniary interest, if any, therein. This report shall not be deemed to be an admission that Mr. Fagnan is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
7. Each share of preferred stock automatically converted into Common Stock on a 1-for-2 basis upon the closing of the Issuer's initial public offering. The shares have no expiration date.
/s/ Frank Castellucci, attorney-in-fact 05/08/2018
** 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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