SEC Form 3
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
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1. Name and Address of Reporting Person*
Indig Chaim

(Last) (First) (Middle)
C/O PHREESIA, INC.
432 PARK AVENUE SOUTH, 12TH FLOOR

(Street)
NEW YORK NY 10016

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/17/2019
3. Issuer Name and Ticker or Trading Symbol
Phreesia, Inc. [ PHR ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
5. 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 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)
Common Stock 827,672(1) D
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)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to Buy) (2) 08/19/2023 Common Stock 227,550 $0.84 D
Stock Option (Right to Buy) (2) 12/18/2024 Common Stock 455,100 $2.03 D
Stock Option (Right to Buy) (3) 01/30/2028 Common Stock 227,550 $4.71 D
Stock Option (Right to Buy) (4) 03/26/2029 Common Stock 511,987 $8.03 D
Explanation of Responses:
1. Includes 255,993 Restricted Stock Units ("RSUs") issued under the Phreesia, Inc. 2018 Stock Option and Grant Plan. Each RSU represents the right to receive one share of Common Stock.
2. This option is fully vested and exercisable as of the date hereof.
3. 25% of this option vested and became exercisable on January 31, 2019, with the remainder vesting in thirty-six (36) equal monthly installments thereafter.
4. 25% of this option shall vest and become exercisable on January 17, 2020, with the remainder vesting in three (3) equal annual installments thereafter.
Remarks:
Exhibit 24 - Power of Attorney
/s/ Charles Kallenbach by Power of Attorney for Chaim Indig 07/17/2019
** 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.
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