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
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Solomon Glenn

(Last) (First) (Middle)
C/O DOMO, INC.
772 EAST UTAH VALLEY DRIVE

(Street)
AMERICAN FORK UT 84003

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/28/2018
3. Issuer Name and Ticker or Trading Symbol
DOMO, INC. [ DOMO ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
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)
Class B Common Stock 20,000(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
Series A Preferred Stock (2) (2) Class B Common Stock 29,643 (2) I See footnote(3)
Series C Preferred Stock (2) (2) Class B Common Stock 515,496 (2) I See footnote(3)
Series D Preferred Stock (2) (2) Class B Common Stock 78,973 (2) I See footnote(3)
Series A Preferred Stock (2) (2) Class B Common Stock 628 (2) I See footnote(4)
Series C Preferred Stock (2) (2) Class B Common Stock 10,930 (2) I See footnote(4)
Series D Preferred Stock (2) (2) Class B Common Stock 1,674 (2) I See footnote(4)
Series D-2 Preferred Stock (2) (2) Class B Common Stock 197,669 (2) I See footnote(5)
Explanation of Responses:
1. The shares are represented by restricted stock units ("RSUs"). Each RSU represents the Reporting Person's right to receive one share of Class B Common Stock of the Issuer, subject to the applicable vesting schedule. In the event the Reporting Person ceases to be a Service Provider, the unvested RSUs will be cancelled by the Issuer.
2. Each of the Series A Preferred Stock, Series C Preferred Stock, Series D Preferred Stock and Series D-2 Preferred Stock shall automatically convert into shares of Class B Common Stock on a one to one basis immediately prior to the completion of the Issuer's initial public offering of Class B Common Stock and has no expiration date.
3. The reported securities are held directly by GGV Capital IV L.P. GGV Capital IV L.L.C. is the general partner of GGV Capital IV L.P., and the Reporting Person, as a managing director of GGV Capital IV L.L.C., may be deemed to share voting and investment control over these shares. The Reporting Person disclaims beneficial ownership of the securities held by GGV Capital IV L.P. except to the extent of any pecuniary interest therein.
4. The reported securities are held directly by GGV Capital IV Entrepreneurs Fund L.P. GGV Capital IV L.L.C. is the general partner of GGV Capital IV Entrepreneurs Fund L.P., and the Reporting Person, as a managing director of GGV Capital IV L.L.C., may be deemed to share voting and investment control over these shares. The Reporting Person disclaims beneficial ownership of the securities held by GGV Capital IV Entrepreneurs Fund L.P. except to the extent of any pecuniary interest therein.
5. The reported securities are held directly by GGV Capital Select L.P. GGV Capital Select L.L.C. is the general partner of GGV Capital Select L.P., and the Reporting Person, as a managing director of GGV Capital Select L.L.C., may be deemed to share voting and investment control over these shares. The Reporting Person disclaims beneficial ownership of the securities held by GGV Capital Select L.P. except to the extent of any pecuniary interest therein.
Remarks:
Exhibit 24 Power of Attorney
/s/ Daniel Stevenson, attorney-in-fact 06/28/2018
** 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 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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.